0:01

So this particular case, what we are

0:02

seeing here, there is a complex lesion,

0:05

multiloculated, multiseptated, lobulated

0:08

in outline, situated along with the

0:10

uncinate process and the pancreatic head.

0:12

And this lesion actually shows

0:13

some kind of intermediate intensity

0:15

inside, at different locations.

0:18

It's not just one location.

0:20

And septation also looking

0:22

thicker and irregular here.

0:25

So this lesion doesn't look very good.

0:27

So let's see how big it is.

0:28

If we measure this lesion together, it's almost

0:32

3.3 cm in length.

0:35

So this falls in the category

0:36

where the lesion is more than 3 cm.

0:39

It has shown thick and irregular

0:42

internal septation, and there are few

0:45

questionable areas of internal intensity.

0:47

For example, this one.

0:48

On the posterior wall, we can see this

0:51

intensity which looks very worrisome.

0:54

So the question is whether this is

0:55

really a cancer developing on the, on the

0:58

background of side branch IPMN or not.

1:00

So what we will do, we will go to the post

1:02

contrast images and see how this behaves.

1:05

So, in this particular case, we are

1:07

seeing some kind of enhancement in those

1:09

areas, and the separations are looking

1:11

very irregular and thickened everywhere.

1:15

And all those areas, those were intermediate,

1:17

are showing enhancement on post-contrast images.

1:21

Possibly better will be seen on Venus phase.

1:27

So, all of these areas are looking

1:28

very suspicious, and let us see if

1:31

we have any comparison available.

1:33

So, if we go backwards, almost 10 years

1:35

back, we have a CT available in the system.

1:39

Which shows the same lesion, which was very small.

1:43

It was barely visible here.

1:44

10 years back, it was looking

1:46

like a complex hypodensity there.

1:48

And the lesion measured 1.6 cm.

1:51

1:52

So this lesion actually grew over the period

1:53

of 10 years and developed thick enhancing

1:56

septations inside, which were enhancing on the MR.

2:01

It looks suspicious even before maybe.

2:03

There were septations before, but the

2:04

enhancing component was not that great.

2:07

And once we biopsied it,

2:09

it turned out to be malignancy.

2:11

So this was a malignant transformation of the side

2:13

branch IPMN over the period of 10 years, which

2:15

can happen in about 20 percent of the patients.