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MDCT of Intraductal Papillary Mucinous Neoplasm of the Pancreas: Evaluation of Features Predictive of Invasive Carcinoma

Satomi Kawamoto1, Leo P. Lawler1, Karen M. Horton1, John Eng1, Ralph H. Hruban2 and Elliot K. Fishman1

1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287.
2 Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Hospital, Baltimore, MD 21287.


Figure 1
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  		Fig. 1A —Patient with invasive carcinoma arising in intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images show diffuse dilatation of main pancreatic duct (11.5 mm) (arrowheads, B), which was classified as diffuse main duct type. Note apparent soft-tissue mass in head (arrows, B) of pancreas. Pathologically, 2.5-cm invasive carcinoma was seen arising in IPMN and extending into duodenal wall.

 

Figure 2
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  		Fig. 1B —Patient with invasive carcinoma arising in intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images show diffuse dilatation of main pancreatic duct (11.5 mm) (arrowheads, B), which was classified as diffuse main duct type. Note apparent soft-tissue mass in head (arrows, B) of pancreas. Pathologically, 2.5-cm invasive carcinoma was seen arising in IPMN and extending into duodenal wall.

 

Figure 3
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  		Fig. 2A —Patient with intraductal papillary mucinous neoplasm (IPMN) borderline lesion. Axial (A) and coronal (B) reformatted venous phase images show dilatation (4.6 mm) of main pancreatic duct (arrowheads) in pancreatic tail. This was classified as main duct type with segmental involvement. Pathologically, it was IPMN borderline lesion.

 

Figure 4
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  		Fig. 2B —Patient with intraductal papillary mucinous neoplasm (IPMN) borderline lesion. Axial (A) and coronal (B) reformatted venous phase images show dilatation (4.6 mm) of main pancreatic duct (arrowheads) in pancreatic tail. This was classified as main duct type with segmental involvement. Pathologically, it was IPMN borderline lesion.

 

Figure 5
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  		Fig. 3A —Patient with invasive carcinoma arising in intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images show 5-cm cystic and solid mass (arrows) in head of pancreas. No main pancreatic duct dilatation is seen. Lesion was classified as branch duct type, cystic and solid lesion. Common bile duct (arrowhead, B) is 9.8 mm in caliber. Pathologically, 4.0-cm invasive carcinoma was seen arising in IPMN and infiltrating duodenal wall and peripancreatic soft tissue.

 

Figure 6
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  		Fig. 3B —Patient with invasive carcinoma arising in intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images show 5-cm cystic and solid mass (arrows) in head of pancreas. No main pancreatic duct dilatation is seen. Lesion was classified as branch duct type, cystic and solid lesion. Common bile duct (arrowhead, B) is 9.8 mm in caliber. Pathologically, 4.0-cm invasive carcinoma was seen arising in IPMN and infiltrating duodenal wall and peripancreatic soft tissue.

 

Figure 7
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  		Fig. 4A —Microscopic foci of invasive carcinoma arising in patient with intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images shows 5-cm cystic mass in head and uncinate process (arrows) and mild dilatation (6.5 mm) of main pancreatic duct (arrowheads, B). This lesion was classified as combined type, cystic and solid lesion. Pathologically, microscopic foci of invasive carcinoma were seen arising in IPMN.

 

Figure 8
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  		Fig. 4B —Microscopic foci of invasive carcinoma arising in patient with intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images shows 5-cm cystic mass in head and uncinate process (arrows) and mild dilatation (6.5 mm) of main pancreatic duct (arrowheads, B). This lesion was classified as combined type, cystic and solid lesion. Pathologically, microscopic foci of invasive carcinoma were seen arising in IPMN.

 

Figure 9
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  		Fig. 5A —Patient with invasive carcinoma arising in intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images show 6-cm cystic mass in head of pancreas (arrows). Mild dilatation (< 10 mm) of main pancreatic duct is not shown. Common bile duct (arrowhead, B) is dilated (16 mm). Lesion was classified as combined type, cystic and solid lesion. Pathologically, invasive carcinoma measuring 5.5 cm in greatest dimension was seen arising in IPMN.

 

Figure 10
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  		Fig. 5B —Patient with invasive carcinoma arising in intraductal papillary mucinous neoplasm (IPMN). Axial (A) and coronal (B) reformatted venous phase images show 6-cm cystic mass in head of pancreas (arrows). Mild dilatation (< 10 mm) of main pancreatic duct is not shown. Common bile duct (arrowhead, B) is dilated (16 mm). Lesion was classified as combined type, cystic and solid lesion. Pathologically, invasive carcinoma measuring 5.5 cm in greatest dimension was seen arising in IPMN.

 

Figure 11
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  		Fig. 6A —Patient with intraductal papillary mucinous neoplasm (IPMN) adenoma. Axial (A) and coronal (B) reformatted venous phase images show small cystic lesion in body of pancreas (arrows). Main pancreatic duct is visualized but not dilated (arrowheads, A). Lesion was classified as branch duct type, cystic with thin septations. Pathologically, lesion was IPMN adenoma.

 

Figure 12
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  		Fig. 6B —Patient with intraductal papillary mucinous neoplasm (IPMN) adenoma. Axial (A) and coronal (B) reformatted venous phase images show small cystic lesion in body of pancreas (arrows). Main pancreatic duct is visualized but not dilated (arrowheads, A). Lesion was classified as branch duct type, cystic with thin septations. Pathologically, lesion was IPMN adenoma.

 

Figure 13
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  		Fig. 7A —Patient with intraductal papillary mucinous neoplasm (IPMN) borderline lesion. Axial (A) and coronal (B) reformatted venous phase images show cystic lesion in head and uncinate process (3.3 cm) (white arrows). Note mild dilatation (4 mm) of main pancreatic duct (arrowhead, A). Pancreatic stent (black arrow, A) is present. Lesion was classified as combined type, solid and cystic lesion. Pathologically, lesion was IPMN borderline lesion.

 

Figure 14
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  		Fig. 7B —Patient with intraductal papillary mucinous neoplasm (IPMN) borderline lesion. Axial (A) and coronal (B) reformatted venous phase images show cystic lesion in head and uncinate process (3.3 cm) (white arrows). Note mild dilatation (4 mm) of main pancreatic duct (arrowhead, A). Pancreatic stent (black arrow, A) is present. Lesion was classified as combined type, solid and cystic lesion. Pathologically, lesion was IPMN borderline lesion.

 

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