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Microcystic Features at US: A Nonspecific Sign for Microcystic Adenomas of the Pancreas¹

¹ From the Department of Radiology, Mount Sinai-NYU Medical Center, One Gustave L. Levy Pl, Box 1234, New York, NY 10029. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received January 31, 2001; revision requested March 6 and final revision received August 28; accepted August 29. Address correspondence to H.C.Y. (e-mail: hsu-chong.yeh@mountsinai.org).

View larger version (117K): [in a new window]   Figure 1.   Adenocarcinoma. Transverse US image shows a mass in the pancreatic head (arrow) containing numerous small cysts (arrowheads).

View larger version (148K): [in a new window]   Figure 2.   Adenocarcinoma. Coronal US image of the spleen (S) shows a mass in the tail of the pancreas (arrows) containing multiple small cysts (arrowheads).

View larger version (123K): [in a new window]   Figure 3.   Mucinous cystadenocarcinoma in a 75-year-old man. Oblique US image shows a mass in the pancreatic head (arrowheads) containing multiple small cysts. There was also a larger, 2 x 1.8-cm cyst (not shown). The common bile duct (arrow) is dilated due to obstruction by the mass. The gallbladder is also dilated and contains biliary sludge that forms a level.

View larger version (160K): [in a new window]   Figure 4a.   Mucinous cystadenocarcinoma of the entire pancreas in a 68-year-old man. (a) Transverse US image shows multiple small cysts in the pancreatic head and body (arrowhead). A 3-cm cyst is vaguely seen in the pancreatic tail (arrows). A = aorta, V = inferior vena cava. (b) Oblique sagittal US image obtained in the epigastric region and oriented toward the left side shows numerous small cysts in the tail of the pancreas (arrowhead). The 3-cm cyst is now more clearly seen at the distal end of the pancreatic tail (arrows). The walls of these cysts are not clearly delineated, making it more difficult to determine the cystic nature of the lesions at US than at CT. However, good through transmission is evident. Aspiration showed turbid dark brown fluid that revealed mucinous cystadenocarcinoma at cytologic examination. (c) CT scan corresponding to a shows numerous small cysts throughout the entire pancreas. The superior mesenteric artery (a) and superior mesenteric vein (V) are encased by the mass, indicating that the mass may be malignant. (d) CT scan obtained slightly inferior to c shows a 3-cm cyst in the distal tail of the pancreas (arrowhead). a = superior mesenteric artery, V = superior mesenteric vein.

View larger version (152K): [in a new window]   Figure 4b.   Mucinous cystadenocarcinoma of the entire pancreas in a 68-year-old man. (a) Transverse US image shows multiple small cysts in the pancreatic head and body (arrowhead). A 3-cm cyst is vaguely seen in the pancreatic tail (arrows). A = aorta, V = inferior vena cava. (b) Oblique sagittal US image obtained in the epigastric region and oriented toward the left side shows numerous small cysts in the tail of the pancreas (arrowhead). The 3-cm cyst is now more clearly seen at the distal end of the pancreatic tail (arrows). The walls of these cysts are not clearly delineated, making it more difficult to determine the cystic nature of the lesions at US than at CT. However, good through transmission is evident. Aspiration showed turbid dark brown fluid that revealed mucinous cystadenocarcinoma at cytologic examination. (c) CT scan corresponding to a shows numerous small cysts throughout the entire pancreas. The superior mesenteric artery (a) and superior mesenteric vein (V) are encased by the mass, indicating that the mass may be malignant. (d) CT scan obtained slightly inferior to c shows a 3-cm cyst in the distal tail of the pancreas (arrowhead). a = superior mesenteric artery, V = superior mesenteric vein.

View larger version (156K): [in a new window]   Figure 4c.   Mucinous cystadenocarcinoma of the entire pancreas in a 68-year-old man. (a) Transverse US image shows multiple small cysts in the pancreatic head and body (arrowhead). A 3-cm cyst is vaguely seen in the pancreatic tail (arrows). A = aorta, V = inferior vena cava. (b) Oblique sagittal US image obtained in the epigastric region and oriented toward the left side shows numerous small cysts in the tail of the pancreas (arrowhead). The 3-cm cyst is now more clearly seen at the distal end of the pancreatic tail (arrows). The walls of these cysts are not clearly delineated, making it more difficult to determine the cystic nature of the lesions at US than at CT. However, good through transmission is evident. Aspiration showed turbid dark brown fluid that revealed mucinous cystadenocarcinoma at cytologic examination. (c) CT scan corresponding to a shows numerous small cysts throughout the entire pancreas. The superior mesenteric artery (a) and superior mesenteric vein (V) are encased by the mass, indicating that the mass may be malignant. (d) CT scan obtained slightly inferior to c shows a 3-cm cyst in the distal tail of the pancreas (arrowhead). a = superior mesenteric artery, V = superior mesenteric vein.

View larger version (146K): [in a new window]   Figure 4d.   Mucinous cystadenocarcinoma of the entire pancreas in a 68-year-old man. (a) Transverse US image shows multiple small cysts in the pancreatic head and body (arrowhead). A 3-cm cyst is vaguely seen in the pancreatic tail (arrows). A = aorta, V = inferior vena cava. (b) Oblique sagittal US image obtained in the epigastric region and oriented toward the left side shows numerous small cysts in the tail of the pancreas (arrowhead). The 3-cm cyst is now more clearly seen at the distal end of the pancreatic tail (arrows). The walls of these cysts are not clearly delineated, making it more difficult to determine the cystic nature of the lesions at US than at CT. However, good through transmission is evident. Aspiration showed turbid dark brown fluid that revealed mucinous cystadenocarcinoma at cytologic examination. (c) CT scan corresponding to a shows numerous small cysts throughout the entire pancreas. The superior mesenteric artery (a) and superior mesenteric vein (V) are encased by the mass, indicating that the mass may be malignant. (d) CT scan obtained slightly inferior to c shows a 3-cm cyst in the distal tail of the pancreas (arrowhead). a = superior mesenteric artery, V = superior mesenteric vein.

View larger version (127K): [in a new window]   Figure 5.   Lymphoma. Transverse US image shows a mass in the body and proximal tail of the pancreas (arrows). Multiple small (<1-cm) cysts and a 1.5-cm cyst are seen in the mass.

View larger version (133K): [in a new window]   Figure 6.   Metastasis from cystadenocarcinoma of the bile duct. Transverse US image shows a large mass in the head of the pancreas (arrowheads) containing multiple cysts. Although two cysts are slightly larger (up to 3 cm in diameter), most of the cysts are less than 1.5 cm.

View larger version (118K): [in a new window]   Figure 7a.   Microcystic adenoma in a 78-year-old woman. Transverse US image (a) and corresponding CT scan (b) show a mass in the head of the pancreas (arrowhead) containing multiple small cysts. a = superior mesenteric artery, v = superior mesenteric vein.

View larger version (105K): [in a new window]   Figure 7b.   Microcystic adenoma in a 78-year-old woman. Transverse US image (a) and corresponding CT scan (b) show a mass in the head of the pancreas (arrowhead) containing multiple small cysts. a = superior mesenteric artery, v = superior mesenteric vein.

View larger version (117K): [in a new window]   Figure 8a.   Microcystic adenoma in a 51-year-old woman. (a) Transverse US image shows a mass in the head of the pancreas (arrowheads) containing multiple small cysts. (b) US image obtained with the patient in the decubitus position shows a dilated common bile duct (D) and gallbladder (G) due to obstruction by the pancreatic mass (arrowheads).

View larger version (141K): [in a new window]   Figure 8b.   Microcystic adenoma in a 51-year-old woman. (a) Transverse US image shows a mass in the head of the pancreas (arrowheads) containing multiple small cysts. (b) US image obtained with the patient in the decubitus position shows a dilated common bile duct (D) and gallbladder (G) due to obstruction by the pancreatic mass (arrowheads).

View larger version (159K): [in a new window]   Figure 9.   Focal pancreatitis. Transverse US image shows a mass in the pancreatic head (arrowhead) filled with small cysts due to focal pancreatitis.

View larger version (102K): [in a new window]   Figure 10a.   Chronic pancreatitis associated with diffuse cystic changes. (a) Transverse US image shows the pancreatic head and body filled with small (<2-cm) cysts. (b) Coronal US image of the spleen (S) shows small cysts in the tail of the pancreas (arrowheads). (c) CT scan corresponding to a shows the pancreas filled with small cysts. (d) CT scan corresponding to b also demonstrates numerous small cysts filling the tail of the pancreas (arrowhead). Aspiration showed whitish milky or semipurulent intracystic fluid due to chronic infection.

View larger version (96K): [in a new window]   Figure 10b.   Chronic pancreatitis associated with diffuse cystic changes. (a) Transverse US image shows the pancreatic head and body filled with small (<2-cm) cysts. (b) Coronal US image of the spleen (S) shows small cysts in the tail of the pancreas (arrowheads). (c) CT scan corresponding to a shows the pancreas filled with small cysts. (d) CT scan corresponding to b also demonstrates numerous small cysts filling the tail of the pancreas (arrowhead). Aspiration showed whitish milky or semipurulent intracystic fluid due to chronic infection.

View larger version (107K): [in a new window]   Figure 10c.   Chronic pancreatitis associated with diffuse cystic changes. (a) Transverse US image shows the pancreatic head and body filled with small (<2-cm) cysts. (b) Coronal US image of the spleen (S) shows small cysts in the tail of the pancreas (arrowheads). (c) CT scan corresponding to a shows the pancreas filled with small cysts. (d) CT scan corresponding to b also demonstrates numerous small cysts filling the tail of the pancreas (arrowhead). Aspiration showed whitish milky or semipurulent intracystic fluid due to chronic infection.

View larger version (114K): [in a new window]   Figure 10d.   Chronic pancreatitis associated with diffuse cystic changes. (a) Transverse US image shows the pancreatic head and body filled with small (<2-cm) cysts. (b) Coronal US image of the spleen (S) shows small cysts in the tail of the pancreas (arrowheads). (c) CT scan corresponding to a shows the pancreas filled with small cysts. (d) CT scan corresponding to b also demonstrates numerous small cysts filling the tail of the pancreas (arrowhead). Aspiration showed whitish milky or semipurulent intracystic fluid due to chronic infection.