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Pancreatic Intraductal Papillary Mucinous Neoplasms: Role of CT in Predicting Pathologic Subtypes

Rahul Gupta1, Koenraad J. Mortelé1, Servet Tatli1, Jeffrey Girshman1, Jonathan N. Glickman2, Angela D. Levy3,4, Sukru M. Erturk1, Clara S. Heffess5, Peter A. Banks6 and Stuart G. Silverman1

1 Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
2 Department of Pathology, Brigham and Women's Hospital, Boston, MA.
3 Department of Radiologic Pathology, AFIP, Washington, DC.
4 Department of Radiology, Uniformed Services University of Health Sciences, Bethesda, MD.
5 Department of Endocrine and Rhino-Oto-Laryngic-Head and Neck Pathology, AFIP, Washington, DC.
6 Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA.


Figure 1
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  		Fig. 1 —58-year-old woman with chronic left upper quadrant pain. Axial contrast-enhanced CT scan shows 1.9-cm cystic pancreatic mass (arrow) with single pseudoseptation. Histopathologic evaluation after distal pancreatectomy revealed side-branch intraductal papillary mucinous adenoma.

 

Figure 2
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  		Fig. 2 —79-year-old woman with pruritus and jaundice. Axial contrast-enhanced CT scan shows severe dilatation of main pancreatic duct in tail (arrow) and multiple intraductal solid masses (arrowheads) in pancreatic body. There is common bile duct stent. Histopathologic evaluation after subtotal pancreatectomy revealed main duct intraductal papillary mucinous carcinoma with invasion.

 

Figure 3
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  		Fig. 3A —41-year-old woman with acute epigastric pain. Axial contrast-enhanced CT scan shows 2.5-cm cystic mass (arrow) in pancreatic head.

 

Figure 4
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  		Fig. 3B —41-year-old woman with acute epigastric pain. Axial contrast-enhanced CT image at slightly cephalad level compared with A shows communication (arrowhead) that is 2.9 mm wide between mass and mildly (6.6 mm) dilated main pancreatic duct (arrow). Histopathologic evaluation after Whipple procedure revealed side-branch intraductal papillary mucinous adenoma.

 

Figure 5
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  		Fig. 4A —74-year-old woman with chronic abdominal pain. Axial contrast-enhanced CT scan shows 2.6-cm cystic mass (arrow) in uncinate process with associated dilatation of main pancreatic duct (arrowhead).

 

Figure 6
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  		Fig. 4B —74-year-old woman with chronic abdominal pain. Axial contrast-enhanced CT image at slightly caudal level compared with A shows communication (arrowheads) that is 8.2 mm wide between mass and dilated main pancreatic duct (arrow).

 

Figure 7
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  		Fig. 4C —74-year-old woman with chronic abdominal pain. Axial contrast-enhanced CT image at slightly caudal level compared with A reveals main pancreatic duct (arrow) is maximally dilated up to 1.0 cm. Histopathologic evaluation after Whipple procedure revealed intraductal papillary mucinous carcinoma with invasion.

 

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