0:01

So now we'll be dealing with

0:02

pancreatic cystic tumors.

0:04

So most of the cysts in the

0:05

pancreas are usually pseudocysts.

0:07

These are complications of pancreatitis.

0:09

They can be unilocular.

0:11

They may demonstrate internal

0:12

debris on ultrasound or CT or MR.

0:15

As I mentioned, they are pseudocysts

0:16

because they are not lined by epithelium.

0:19

They are acquired by inflammation,

0:20

and that is a pseudocapsule there.

0:22

The true cysts are usually congenital.

0:25

Syndromes like polycystic kidney

0:27

disease or von Neupel-Linder syndrome.

0:30

But the true neoplasm, those are cystic.

0:33

Those can be divided broadly into two

0:35

categories, ductile or extra-ductile.

0:38

Ductile we already dealt with, IPMNs.

0:41

These are usually side-branch IPMNs,

0:43

grape like clusters, and they are usually seen

0:44

in head and uncinate process and usually

0:47

more in the males rather than the females.

0:50

And we discussed all the

0:51

management on the previous slides.

0:53

The extra-ductile lesions are broadly

0:55

divided into three categories.

0:57

Macrocystic, Microcystic, or solid cystic.

1:01

The macrocystic are basically mucinous tumors.

1:04

Those are usually seen in middle-aged

1:07

females, or they're also called as mom tumors.

1:11

So age group we can see like mom, tumor,

1:14

grand tumor, and this is daughter tumor

1:18

because they're young females here.

1:20

So macrocystic tumors, those are mucinous tumor.

1:23

Those are mom's tumors seen in middle

1:24

aged females, and they may demonstrate

1:27

peripheral calcification, but that

1:28

will be seen only on CT, not on MR.

1:31

They can be mostly seen on tail, but they

1:33

can be seen anywhere and they secrete mucin

1:36

and they have malignant potential like any

1:39

mucinous tumor and they will undergo surgery.

1:43

The microcystic tumor or grandma tumor, those are

1:46

seen in the females more than 60 years of age.

1:50

They are showing small cysts measuring

1:53

less than 2 cm and more in number.

1:56

So they classically demonstrate a pattern

1:58

which is called honeycombing, and they

2:01

can show calcification or central scar.

2:03

They are usually centered.

2:05

In this case, it was peripheral, and

2:08

it can be usually seen in the proximal

2:11

pancreas, in the head or the body of the

2:13

pancreas, and they are serous tumors.

2:16

So remember, serous are not serious, so they do

2:19

not require surgery; they will undergo follow-up.

2:23

Mucinous are serious; they will undergo surgery.

2:25

Serous are not serious,

2:26

they will undergo follow-up.

2:28

And they are honeycombed,

2:29

and they are macrocystic.

2:31

And different age groups.

2:33

And then comes the solid cystic.

2:36

So these tumors are usually showing

2:39

some hemorrhagic content and necrosis

2:40

and situated in the tail region.

2:43

Solid cystic tumors are mostly seen in

2:45

the young females of 30 to 40 years.

2:47

That's why they're called daughter's tumors.

2:50

And these are solid papillary epithelial

2:53

neoplasms, and they will also undergo

2:57

surgery because there is potential to develop

2:59

cancers in about three to 4 percent of cases.