0:01

So, another case with another cystic

0:02

lesion in the pancreas, and what we are

0:05

seeing, there is a lesion here, which has

0:08

less than three cysts packed together.

0:11

Some of these cysts are smaller, but the largest

0:13

cyst we are seeing here is measuring almost

0:18

2.4 centimeters, and if we see these cysts in the

0:21

coronal, we can find that the number of cysts are

0:23

less than six, and they are separated with thick

0:26

separations, and these cysts are measuring,

0:31

some of the cysts are measuring about

0:33

1.5, 1.4 centimeters here

0:36

0:38

Actually, it is bigger than that.

0:39

If we look at the other section,

0:42

it is slightly bigger than that.

0:43

So, it is almost like 1.8 centimeters.

0:46

0:46

And the similar thing can happen

0:47

here that it is a curved or obliquely

0:49

placed cyst, which is seen smaller.

0:52

Overall, what we are seeing here, there are

0:54

less than 6 number of cysts, thick internal

0:58

adaptations situated in distal pancreas.

1:01

And this is a patient who is about

1:04

45 years old and a female patient.

1:08

So, if we have a mom age group here,

1:11

which is showing a lesion, cystic lesion in the

1:12

distal pancreas and which is showing less

1:15

than six number of cysts separated by thick

1:18

septations and the cysts are measuring about

1:20

2 centimeters closer to that or more than that.

1:23

We should lean towards a

1:24

diagnosis of mucinous tumor.

1:27

Only thing it can be IPMN that you have to

1:29

rule out on post-contrast images if we can see

1:33

any communication with the main duct or not.

1:37

So as we go further and we see carefully this,

1:40

these lesions, so if we see here like there

1:43

are thick separations, those are enhancing.

1:46

But we are not able to demonstrate any

1:48

communication with the duct at least on

1:50

these images, but this is arterial phase.

1:52

To demonstrate communication, we can rely

1:54

more on the venous phase if we can find more.

1:58

So, duct comes here, just disappears, possibly it

2:01

is just displaced peripherally, and those cystic

2:05

lesions are seen better on post-contrast images

2:08

because they are showing some kind of extension.

2:11

So this is not an individual cyst here.

2:13

On T2-weighted images, we thought it is

2:15

the individual cyst in this location.

2:17

But that cyst actually has an extension,

2:19

finger-like extension on the backside,

2:21

which was not seen on T2 due to some reason.

2:23

And same thing is happening here.

2:24

Another cyst, along with the inferior aspect,

2:28

is present here, which is possibly bilobulated.

2:31

And this, what we are seeing,

2:32

is a separation inside.

2:35

So overall, if you keep all the imaging features

2:37

together, distal pancreas, age group, gender,

2:41

number of cysts, thick enhancing separation

2:43

inside, and no communication, or no obvious

2:46

communication with the pancreatic duct. Given

2:48

these images, it falls into the category

2:50

that it qualifies for the mucinous tumor.

2:53

And remember, mucinous tumor has premalignant

2:55

potential, and they should be operated.