Imaging Pearls ❯ Pancreas ❯ Mucinous cystic neoplasm (MCN)
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Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0..- Pancreatic mucinous cystic neoplasms (MCNs) are benign lesions with potential for malignant transformation. Accurate differentiation from other pancreatic cystic lesions remains challenging through conventional imaging modalities. Cinematic rendering (CR) is an advanced 3D computed tomography (CT) post-processing technique that generates photorealistic images with enhanced texture mapping and improved anatomical detail. It has not been previously discussed as a diagnostic tool for MCNs. Through added depth perception and tissue differentiation, CR complements conventional CT by enhancing visualization of morphology, internal components such as septations, calcification patterns, vascular involvement, and features suspicious of malignancy. It also helps with assessment of resectability and surgical planning by clearly highlighting vascular involvement. It is of note that further research is needed to quantify its added diagnostic value and optimize its role in clinical decisions in the evaluation of MCNs.
- Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - MCNs demonstrate a female predominance, occurring in approximately 84.5% of cases, with a mean age at diagnosis between 40 and 60 years. However, male patients with MCNs exhibit significantly higher malignancy rates (47.2%) compared to females (16.6%). As for location, MCNs are most commonly found in the pancreatic body and tail, accounting for 93–95% of cases. The prevalence of invasive carcinoma arising from MCNs ranges between 6 and 55%, and can be present even in asymptomatic patients . The clinical presentation of MCNs range from an incidental finding to symptoms such as epigastric fullness, a palpable abdominal mass, or abdominal and back pain.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - Advanced imaging techniques, including three-dimensional (3D) visualization, may show potential to better characterize pancreatic cystic lesions. Cinematic rendering (CR) is a recently implemented 3D CT post-processing technique that generates photorealistic images with enhanced texture mapping and improved depiction of anatomical detail compared to conventional two-dimensional imaging. To our knowledge, while CR imaging features of other cystic lesions and malignancies have been reported, those specific to MCNs have not been previously described in detail in the literature.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - Notably, there is currently a lack of robust statistical data and comprehensive comparative research assessing the clinical utility and accuracy of CR. Large scale studies are needed to validate its potential both as an adjunct to, and in direct comparison with conventional CT. Moreover, achieving the full potential of advanced 3D techniques like CR requires sufficient contrast enhancement, high quality source images, dedicated software, and radiologists who are experts in these methods. Differences in imaging protocols, software iterations, and reconstruction parameters may also limit reproducibility. Additionally, any patient or scanner based artifacts are reflected in the 3D reconstruction.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - CR is routinely used to evaluate pancreatic lesions because it provides a comprehensive view of pancreatic morphology and increased tissue contrast and shadowing can potentially help with the characterization of pancreatic cystic neoplasms. The lighting mode of cinematic rendering uses multiple light sources and reviews the images as a volume, not as a single slice, and the user controls the size of the volume display. This volume display is especially valuable when looking at different tissue types and is instrumental when creating vascular maps for accurate tumor staging or preoperative planning. Drawing on our extensive experience, we have developed optimized rendering parameters tailored for pancreatic pathology.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - MCNs are macrocystic lesions of the pancreas, that are characterized by a unilocular cyst or a mass composed of a few larger cysts (> 2 cm), ranging from 1.5 to 15 cm in size. MCNs most commonly originate from the body and tail of the pancreas and can exhibit an exophytic growth pattern. They typically demonstrate a round or oval shape with smooth, well-defined borders that often lack external lobulations. A characteristic feature of MCNs is the presence of a thick fibrotic wall that demonstrates enhancement on contrast-enhanced CT images, and a lack of invasion of surrounding structures or vessels.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - Importantly, MCNs do not communicate with the main pancreatic duct. This is a key feature that distinguishes them from IPMNs. CR’s inherent ability to display spatial relationships between structures can help depict the separation between the pancreatic duct and cyst. This anatomical detail can help illustrate the separation of duct and cyst that define MCNs, or reveal any ductal involvement seen in lesions such as SCAs or IPMNs. MCNs appear hypodense relative to the surrounding pancreatic parenchyma on CT, with fluid range internal attenuation that reflects their mucinous contents. However, complex fluid density may also be observed due to internal hemorrhage or debris.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - The chances of malignancy, including high-grade dysplasia and invasive carcinoma, increase as cyst complexity increases. This complexity may manifest as thickened septations, wall irregularity, larger cyst size, and internal enhancing solid components such as mural nodules. These features may be subtle on conventional imaging but need to be carefully evaluated. CR can potentially improve the detection of malignant changes through its enhanced surface shadows and dynamic textural visualization, making features such as septal thickening, wall irregularity, and internal density changes more visible. These changes in attenuation are rendered as differing visual contrasts on CR, which can help identify internal complexity that might otherwise be overlooked on conventional CT .This can potentially lead to early detection of invasive carcinoma.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - The chances of malignancy, including high-grade dysplasia and invasive carcinoma, increase as cyst complexity increases. This complexity may manifest as thickened septations, wall irregularity, larger cyst size, and internal enhancing solid components such as mural nodules. These features may be subtle on conventional imaging but need to be carefully evaluated. CR can potentially improve the detection of malignant changes through its enhanced surface shadows and dynamic textural visualization, making features such as septal thickening, wall irregularity, and internal density changes more visible. These changes in attenuation are rendered as differing visual contrasts on CR, which can help identify internal complexity that might otherwise be overlooked on conventional CT .This can potentially lead to early detection of invasive carcinoma.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0.. - MCNs of the pancreas pose a diagnostic challenge as their imaging features overlap with those of other cystic lesions and diagnosis based on imaging can be difficult. However, accurate identification is essential given that they are premalignant lesions. Some characteristic CT features of MCNs include macrocystic architecture, thick enhancing walls, smooth contours, absence of main pancreatic duct communication, and location in the pancreatic body and tail. The 3D visualization that CR provides can help identify these features, supplementing conventional CT in the evaluation of MCNs. Furthermore CR has to potential to help detect features suggestive of malignancy such as enhancing mural nodules, irregular walls, complex internal contents, and calcifications.
Cinematic rendering in pancreatic imaging: CT features and malignancy indicators of mucinous cystic neoplasms.
Rahmatullah ZF, Krueger S, Smith CW, Soyer P, Chu LC, Fishman EK.
Abdom Radiol (NY). 2026 May 20. doi: 10.1007/s00261-026-05568-0..
- IMPORTANCE With advancements in imaging technology and more frequent health evaluations, the incidence and prevalence of pancreatic cysts have gradually increased. Certain types of pancreatic cystic neoplasms are precancerous lesions associated with an increased risk of pancreatic cancer. Hence, identifying risk factors and preventing their occurrence are crucial. Nonetheless, population-based research on modifiable risk factors remains lacking.
Pancreatic Cystic Neoplasm Risk Among Individuals With Diabetes.
Cho IR, Chang SH, Lee SH, et al.
JAMA Netw Open. 2026;9(2):e2556951. doi:10.1001/jamanetworkopen.2025. 6951 - In this cohort study of 3 856 676 Korean adults, longer diabetes duration was associated with a modestly increased risk of PCNs after adjustment for major confounding factors, particularly among younger individuals, male individuals, and current smokers. Although these findings do not establish causality, they suggest that metabolic dysregulation may be a factor in pancreatic cyst development. Despite the inherent limitations of the claims-based design, this study provides valuable epidemiologic evidence linking diabetes to PCNs in a large nationwide population. Health care professionals should consider these factors, especially when evaluating pancreatic findings in patients with diabetes and additional risk factors. Further prospective studies incorporating imaging and molecular data are warranted to clarify the clinical significance and biological mechanisms underlying this association.
Pancreatic Cystic Neoplasm Risk Among Individuals With Diabetes.
Cho IR, Chang SH, Lee SH, et al.
JAMA Netw Open. 2026;9(2):e2556951. doi:10.1001/jamanetworkopen.2025. 6951 - Question Is diabetes associated with an increased risk of developing pancreatic cystic neoplasms (PCNs)?
Findings In this cohort study of 3 856 676 individuals in Korea followed up for a median of 10 years, longer diabetes duration ( 5 years) was associated with an increased risk of PCNs after adjustment for major confounding factors. This risk was particularly elevated in individuals aged younger than 60 years with diabetes, males with diabetes, and current smokers with diabetes.
Meaning These findings suggest that diabetes may be a factor in the development of PCNs and highlight the potential need for targeted surveillance in individuals with diabetes.
Pancreatic Cystic Neoplasm Risk Among Individuals With Diabetes.
Cho IR, Chang SH, Lee SH, et al.
JAMA Netw Open. 2026;9(2):e2556951. doi:10.1001/jamanetworkopen.2025. 6951 - Mucinous cystic neoplasm (MCN) of pancreas are mucin-producing cystic lesions characterized by the presence of ovarian-type stroma, lacking communication with the pancreatic duct. Management of MCN is guided by lesion size, highrisk imaging features, symptoms, and surgical candidacy. While the AGA and American College of Gastroenterology support surveillance for asymptomatic cysts less than 3 cm without highrisk features (eg, enhancing mural nodules, ductal dilation, or elevated CA 19–9), they advise MR imaging at 1 year and biennial imaging for up to 5 years if stable. Surveillance is not recommended for patients unfit for surgery. Surgical resection remains the standard for symptomatic or high-risk lesions despite its size.
Pancreatic Cancer Screening and Early Detection Current Strategies and Emerging Innovations in Imaging
Shravya Srinivas Rao, et al.
Radiol Clin N Am ▪ (2026) in press
- MCN of the Pancreas
Location: Typically in the body or tail of the pancreas, not connected to the main duct
Demographics: Most common in women, especially around perimenopause (40-60 years old).
Microscopic: Defined by the presence of ovarian-type stroma and mucin-producing columnar cells.
Appearance: Usually a single cyst, sometimes with calcification or thick walls
Many are found incidentally but If symptomatic can present with abdominal pain, mass, nausea, vomiting, or acute pancreatitis. - MCN of the Pancreas
Malignancy Risk & Treatment
Premalignant Potential: MCNs are benign but have a high potential to become cancerous (invasive adenocarcinoma).
Treatment: Surgical removal (resection, often a distal pancreatectomy) is the standard treatment to prevent cancer progression.
Prognosis: Excellent if surgically resected before invasive cancer develops. - MCNs are seen nearly exclusively in women and should be suspected especially in middle-aged women who have typical imaging features, especially in the absence of a history of pancreatitis. MCNs are usually (95% of cases) located in the body or tail of the pancreas. The histologic diagnosis is based on the presence of ovarian stromata. These lesions are extremely rare in male patients, with approximately 12 cases of MCNs with ovarian-like stromata reported.
Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect
Frank H. Miller, Camila Lopes Vendrami, Hannah S. Recht et al.
RadioGraphics 2022; 42:87–105 - It is important to distinguish MCNs from other lesions, including pseudocysts, as they are considered to require surgery on the basis of their malignant potential. Unlike SCAs, MCNs tend to have fewer (<6) and larger (>2 cm) cysts, and they lack external lobulations. These neoplasms may have a “cysts-within-a-cyst” appearance.Like IPMNs, MCNs are found to contain mucin at aspiration, but unlike IPMNs, they do not communicate with the MPD. They often have septa or nodules on imaging studies and may have capsular calcifications that are best appreciated at CT.
Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect
Frank H. Miller, Camila Lopes Vendrami, Hannah S. Recht et al.
RadioGraphics 2022; 42:87–105 - The malignancy rates associated with MCNs range from 10% to 17%. Features associated with malignancy include invasion of adjacent structures, nodal and distant metastases, larger lesion size (cyst ≥4 cm), thick irregular walls, enhancing soft-tissue components or mural nodules, peripheral calcifications, and pancreatic duct dilatation. An MCN in a male should be more concerning for malignancy. Metastases, when present, occur mainly in the liver and are typically cystic. Among MCNs smaller than 4 cm and without worrisome features, malignant transformation has occurred in 0.03% of cases.
Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect
Frank H. Miller, Camila Lopes Vendrami, Hannah S. Recht et al.
RadioGraphics 2022; 42:87–105
- Background: As pancreatic cystic neoplasms (PCN) differ in current standard of care, and these treatments can affect quality of life to varying degrees, a definitive preoperative diagnosis must be reliable. Current diagnostic approaches, specifically traditional cross- sectional imaging techniques, face certain limitations. But radiomics has been shown to have high diagnostic accuracy across a range of diseases. Objective to conduct a comprehensive review of the literature on the use of radiomics to differentiate Mucinous Cystic Neoplasm (MCN) from Serous Cystic Neoplasm (SCN). Methods: This study was comprehensively searched in Pubmed, Scopus and Web of Science databases for meta-analysis of studies that used radiomics to distinguish MCN from SCN. Risk of bias was assessed using the diagnostic accuracy study quality assessment method and combined with sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic (SROC)curve analysis.
Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis
Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D
Acad Radiol 2025; 32:2679–2688 - Results: A total of 884 patients from 8 studies were included in this analysis, including 365 MCN and 519 SCN. The Meta-analysis found that radiomics identified MCN and SCN with high sensitivity and specificity, with combined sensitivity and specificity of 0.84(0.82–0.87) and 0.82(0.79–0.84). The positive likelihood ratio (PLR) and the negative likelihood ratio (NLR) are 5.61(3.72, 8.47) and 0.14(0.09–0.26). In addition, the area under the SROC curve (AUC) was drawn at 0.93. No significant risk of publication bias was detected through the funnel plot analysis. The performances of feature extraction from the volume of interest (VOI) or Using AI classifier in the radiomics models were superior to those of protocols employing region of interest (ROI) or absence of AI classifier. Conclusion: This meta-analysis demonstrates that radiomics exhibits high sensitivity and specificity in distinguishing between MCN and SCN, and has the potential to become a reliable diagnostic tool for their identification.
Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis
Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D
Acad Radiol 2025; 32:2679–2688 - • The pooled sensitivity and specificity of radiomics for differentiating Mucinous Cystic Neoplasm from Serous Cystic Neoplasms were 84% and 82%, respectively.
• The field of radiomics lacks standardization, resulting in substantial variations in statistical analysis where such studies are conducted.
•Radiomics has an excellent diagnostic effect in distinguishing MCN from SCN and providing more critical information.
Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis
Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D
Acad Radiol 2025; 32:2679–2688 - MCN is an uncommon tumor that usually occurs in middle-aged women. Surgery is the treatment of choice, and prognosis is excellent in the absence of invasive carcinoma (8). For SCN, the vast majority are benig. Studies have shown that most patients with SCN do not need surgery unless they have significant symptoms or a preoperative diagnosis is unclear. Therefore, some patients can choose to follow-up. Compared with SCN, MCN has considerable malignant potential, so the guidelines recommend resections for all patients who are suitable for surgery. Therefore, it is important to distinguish MCN from SCN in clinic, but current diagnostic approach (ie, traditional cross-sectional imaging) has limitations. It has been reported that the discrimination efficacy of CT for SCNs was ranged from 43% to 67%
Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis
Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D
Acad Radiol 2025; 32:2679–2688 - “ Our study discovered that radiomics possesses a high degree of accuracy in distinguishing PCNs, particularly in detecting MCN and SCN, making it worthy of promotion for broader application. However, we require additional high-quality research to further validate these findings, and its practical efficiency and clinical applicability also need to be explored further. Moreover, we anticipate establishing standardized radiomics guidelines in the future to provide more evidence for the diagnosis and treatment of pancreatic cystic neoplasms.”
Pancreatic Mucinous Cystic Neoplasm from Serous Cystic Neoplasm: Systematic Review and Meta-Analysis
Longjia Zhang1, Boyu Diao1, Zhiyao Fan1, Hanxiang Zhan, M.D, Ph.D
Acad Radiol 2025; 32:2679–2688
- Background: Mucinous cystic neoplasms of the pancreas are uncommon tumors that have the potential of becoming cancer. There is no consensus regarding the high-risk features of these tumors. Our study aimed to identify the preoperative demographic, clinical, or radiologic factors that can predict the presence of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas.
Conclusion: Tumors with a size 4 cm and/or a high CA 19-9 level should be considered for prompt surgical resection. Conversely, tumors <4 cm with no other high-risk features have a negligible risk for high-grade dysplasia or invasive carcinoma and may benefit from nonoperative surveillance. Mural nodularity is an additional suspicious feature. These findings may contribute to future guidelines.
Identification of high-risk features in mucinous cystic neoplasms of the pancreas
Maximiliano Servin-Rojas et al.
Surgery (2023) in press - Results: The rate of high-grade dysplasia or invasive carcinoma was 11%. Tumor size 4 cm (P < .001), mural nodularity (P . .04), and a serum CA 19-9 level >37 U/mL (P < .001) were associated with high grade dysplasia or invasive carcinoma. In the multivariable analysis, tumor size 4 cm (odds ratio 16.9, 95% confidence interval 2.04e140, P . .009) and a CA 19-9 level >37 U/mL (odds ratio 5.68, 95% confidence interval 1.52e21.3, P ..010) were predictors of high-grade dysplasia or invasive carcinoma. There were no tumors with high-grade dysplasia or invasive carcinoma in patients with tumor size <4 cm in the absence of an elevated CA 19-9 or mural nodularity.
Identification of high-risk features in mucinous cystic neoplasms of the pancreas
Maximiliano Servin-Rojas et al.
Surgery (2023) in press - “In conclusion, in our study, the rate of HGD/IC among patients with a pathologically confirmed diagnosis of MCNs was 11%, which is similar to prior series. Tumor size 4 cm and elevated serum CA 19-9 were significant predictors of HGD/IC in our study. Specifically, tumor size <4 cm could reliably exclude HGD/IC, especially in the absence of other associated high-risk features, such as elevated CA 19-9 or the presence of mural nodularity. These findings appear to distinguish which patients with pancreatic MCNs may benefit from surgical resection versus those who can be spared an operation and associated complications.”
Identification of high-risk features in mucinous cystic neoplasms of the pancreas
Maximiliano Servin-Rojas et al.
Surgery (2023) in press
- “Results: Twenty-five (78%) patients presented with symptoms and 8 (25%) patients had abnormal serum biochemical values. Mean MCN maximum dimensions were 48 9 45 9 45 mm with a mean volume of 169 mL. MCN were located in the tail (n = 18), body (n = 10), neck (n = 2), and (head = 2); 30 (93.5%) MCN were encapsulated, 3 (9%) had calcifications, 4 (12%) showed enhancing nodules, 9 (28%) had enhancing septations, and 5 (15%) had main pancreatic duct dilation. Associated chronic pancreatitis was observed in 4 (12%) patients. The only predictors for high-grade dysplasia/carcinoma were MCN size and volume. Using a cut-off size greater than 8.5 cm, the specificity and sensitivity for high-grade dysplasia/carcinoma were 97 and 60%, respectively (p = 0.003; OR 81, 95% CI 3.9–1655.8). Mean MCN growth rate was estimated at 4.2 mm/year with a doubling time of 8.23 years.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - "MCN size (> 8.5 cm) and volume are the only features on MDCT/MR imaging that correlate with high-grade dysplasia/carcinoma. The average growth rate for MCNs is slow at approximately 4 mm per year.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - "Mucinous cystic neoplasms (MCN) of the pancreas are uncommon tumors that are nearly exclusively seen in middle-aged females. Although the vast majority of MCN are benign at time of diagnosis, they are considered pre-malignant lesions that may become dysplastic and malignant over time. To the best of our knowledge, the exact timeline for this progression is unknown. Needless to say, the ability to predict non-invasively the pathological subtype of MCN can have important advantages and implications. Firstly, biopsy of MCN is prone to sample bias as the epithelial lining of the cyst may be normal in one location but dysplastic or frankly malignant in others. Secondly, MCN with low-grade dysplasia may be treated conservatively with observation rather than surgery, especially in elderly patients with co- morbidities. Lastly, indications for high-grade dysplasia or carcinoma may trigger immediate surgical resection.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - “In our series, all patients were women with a mean age of 45 years. Indeed, MCN is referred to as the ‘mother cyst’ and the previously reported distribution of MCN by gender is 89–99.7% female with a reported mean age at time of diagnosis of 48 years (range, 17–78 years). Presenting clinical signs and symptoms along with serologic biochemical values were also evaluated and correlated with pathology. Although in our cohort 75% of patients presented with at least one symptom, we did not identify any correlation between clinical symptoma- tology with the presence of high-grade dysplasia/carci- noma.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - "In conclusion, MCN size (> 8.5 cm) and volume are the only features on MDCT/MR imaging that correlates with high-grade dysplasia/carcinoma. Moreover, no clinical symptoms, biochemical abnormalities, or pre-operative cyst features previously described as potential predictors high-grade dysplasia/carcinoma could be reproduced. The average growth rate for MCNs is slow at approximately 4 mm per year.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - “Mucinous cystic neoplasms (MCN) of the pancreas are rare, low-grade tumors that occur predominantly in middle-aged women . They are reported to be maligant in about 6–27% of cases. Their most characteristic histopathological finding is the combination of mucin-producing epithelium supported by characteristic ovarian-like stroma that is not found in other pancreatic neoplasms. Furthermore, they usually are com- posed of large (> 2 cm) unilocular or multilocular macrocysts devoid of communication between the cyst and the pancreatic ductal system, and the presence of a fibrous capsule. All MCNs have the potential to transform into an invasive carcinoma, hence the necessity to resect them in their totality.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422
- Pancreatic Cysts on CT: Potentially or Definitely Malignant
- Intraductal Papillary Mucinous Neoplasm
- Mucinous Cystic Neoplasm - Pancreatic Cysts on CT: Definitely Malignant Cystic Lesions
- Solid and Pseudopapillary Epithelial Neoplasms (SPEN)
- Cystic Features of Pancreatic Ductal Adenocarcinoma
- Cystic Neuroendocrine Tumor - "SCNs typically are described as having a honeycomb or multilocular appearance with or without a central scar. However, there can be variations in the morphologic appearance with polycystic, oligocystic, and solid patterns described. Microcystic morphology is more common in SCNs. The classic imaging features are a lobulated external contour and central scar with stellate calcification. SCNs rarely demonstrate peripheral enhancing capsule or mural nodules.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629 - "IPMNs are cystic neoplasms with variable degree of malignant potential. They may evolve into dysplasia or invasive carcinoma and are associated with a higher risk for the development of PDAC in the gland separate from the IPMN sites. The rate of progression increases with time. Low-risk IPMNs have an approximately 8% chance of progression, whereas higher risk IPMNs have an approximately 25% chance of progression to PDAC in 10 years. Even presumed low- risk BD-IPMNs may demonstrate growth after 5 years.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629 - "MCNs occur almost exclusively in women and more commonly are found in the pancreatic tail. MCNs are oval or round and can show septations, cyst wall calcifications, enhancing capsules, and occasionally mural nodules. MCNs typically do not cause dilatation of the biliary or pancreatic ductal system but can be associated with distal pancreatic atrophy. They may be associated with lymphadenopathy but generally are not associated with peripancreatic fat infiltration or vascular involvement.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629 - "Incidental PCs commonly are encountered in a radiology practice. Some cystic masses of the pancreas, in particular pseudocysts, usually can be characterized accurately and adequately by a combination of imaging, history, and follow-up. Other PCs require further evaluation with EUS with FNA. Because some have malignant potential, many PCs require clinical and imaging follow-up. There are several available societal guidelines to help plan patient follow-up, with recent updates. The care of patients with PCs ideally is a multidisciplinary effort among radiologists, pathologists, surgeons, and gastroenterologists for optimal patient management.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629 - • Imaging alone cannot always differentiate benign pancreatic cysts from pancreatic cysts with malignant potential.
• Small indeterminate pancreatic cysts need to be followed-up, since invasive testing and resections are typically reserved for larger or growing cysts or definitively malignant cysts.
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629
- “MCNs occur almost exclusively in women and more commonly are found in the pancreatic tail. MCNs are oval or round and can show septations, cyst wall calcifications, enhancing capsules, and occasionally mural nodules. MCNs typically do not cause dilatation of the biliary or pancreatic ductal system but can be associated with distal pancreatic atrophy. They may be associated with lymphadenopathy but generally are not associated with peripancreatic fat infiltration or vascular involvement.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629 - Cystic Pancreatic Lesions
- Pancreatic Pseudocyst
- Serous cystadenoma
- Lymphoepithelial Cyst
- IPMN
- MCN (Mucinous Cystic Neoplasm)
- Solid and Pseudopapillary Epithelial Neoplasms (SPEN)
- Cystic Features of Pancreatic Ductal Adenocarcinoma
- Cystic Neuroendocrine Tumor - “Predictors of high-grade dysplasia (MCN) include size greater 8.5 cm.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629 - Summary of guidelines for follow-up of incidental pancreatic cysts
- MCN vs SCN using EUS
- “Mucinous cystic neoplasms (MCN) and serous cystic neoplasms (SCN) account for a large portion of solitary pancreatic cystic neoplasms (PCN). In this study we implemented a convolutional neural network (CNN) model using ResNet50 to differentiate between MCN and SCN. The training data were collected retrospectively from 59 MCN and 49 SCN patients from two different hospitals. Data augmentation was used to enhance the size and quality of training datasets. Fine-tuning training approaches were utilized by adopting the pre-trained model from transfer learning while training selected layers. Testing of the network was conducted by varying the endoscopic ultrasonography (EUS) image sizes and positions to evaluate the network performance for differentiation. The proposed network model achieved up to 82.75% accuracy and a 0.88 (95% CI: 0.817–0.930) area under curve (AUC) score.”
Deep Learning-Based Differentiation between Mucinous Cystic Neoplasm and Serous Cystic Neoplasm in the Pancreas Using Endoscopic Ultrasonography
Leang Sim Nguon et al.
Diagnostics 2021, 11, 1052. https://doi.org/10.3390/diagnostics11061052 - “Results: Twenty-five (78%) patients presented with symptoms and 8 (25%) patients had abnormal serum biochemical values. Mean MCN maximum dimensions were 48 9 45 9 45 mm with a mean volume of 169 mL. MCN were located in the tail (n = 18), body (n = 10), neck (n = 2), and (head = 2); 30 (93.5%) MCN were encapsulated, 3 (9%) had calcifications, 4 (12%) showed enhancing nodules, 9 (28%) had enhancing septations, and 5 (15%) had main pancreatic duct dilation. Associated chronic pancreatitis was observed in 4 (12%) patients. The only predictors for high-grade dysplasia/carcinoma were MCN size and volume. Using a cut-off size greater than 8.5 cm, the specificity and sensitivity for high-grade dysplasia/carcinoma were 97 and 60%, respectively (p = 0.003; OR 81, 95% CI 3.9–1655.8). Mean MCN growth rate was estimated at 4.2 mm/year with a doubling time of 8.23 years.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - "MCN size (> 8.5 cm) and volume are the only features on MDCT/MR imaging that correlate with high-grade dysplasia/carcinoma. The average growth rate for MCNs is slow at approximately 4 mm per year.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - "Mucinous cystic neoplasms (MCN) of the pancreas are uncommon tumors that are nearly exclusively seen in middle-aged females. Although the vast majority of MCN are benign at time of diagnosis, they are considered pre-malignant lesions that may become dysplastic and malignant over time. To the best of our knowledge, the exact timeline for this progression is unknown. Needless to say, the ability to predict non-invasively the pathological subtype of MCN can have important advantages and implications. Firstly, biopsy of MCN is prone to sample bias as the epithelial lining of the cyst may be normal in one location but dysplastic or frankly malignant in others. Secondly, MCN with low-grade dysplasia may be treated conservatively with observation rather than surgery, especially in elderly patients with co- morbidities. Lastly, indications for high-grade dysplasia or carcinoma may trigger immediate surgical resection.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - “In our series, all patients were women with a mean age of 45 years. Indeed, MCN is referred to as the ‘mother cyst’ and the previously reported distribution of MCN by gender is 89–99.7% female with a reported mean age at time of diagnosis of 48 years (range, 17–78 years). Presenting clinical signs and symptoms along with serologic biochemical values were also evaluated and correlated with pathology. Although in our cohort 75% of patients presented with at least one symptom, we did not identify any correlation between clinical symptoma- tology with the presence of high-grade dysplasia/carci- noma.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - "In conclusion, MCN size (> 8.5 cm) and volume are the only features on MDCT/MR imaging that correlates with high-grade dysplasia/carcinoma. Moreover, no clinical symptoms, biochemical abnormalities, or pre-operative cyst features previously described as potential predictors high-grade dysplasia/carcinoma could be reproduced. The average growth rate for MCNs is slow at approximately 4 mm per year.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422 - “Mucinous cystic neoplasms (MCN) of the pancreas are rare, low-grade tumors that occur predominantly in middle-aged women . They are reported to be maligant in about 6–27% of cases. Their most characteristic histopathological finding is the combination of mucin-producing epithelium supported by characteristic ovarian-like stroma that is not found in other pancreatic neoplasms. Furthermore, they usually are com- posed of large (> 2 cm) unilocular or multilocular macrocysts devoid of communication between the cyst and the pancreatic ductal system, and the presence of a fibrous capsule. All MCNs have the potential to transform into an invasive carcinoma, hence the necessity to resect them in their totality.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422
- “Mucous producing neoplasms are classified into intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), which have distinct biological characteristics. IPMNs arise in the main pancreatic duct or its major branches, whereas MCNs are large cysts with a thick, peripheral rim of calcifications that do not communicate with the pancreatic ductal system.”
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes Doulamis, Ilias P. et al. International Journal of Surgery , Volume 35 , 76 - 82 - “MCACs are usually symptomatic at the time of diagnosis, with obstructive jaundice and palpable abdominal mass being commonly present (>25%). Notably, portal hypertension, hemobilia and diabetes mellitus constitute signs of aggressive malignancy. Apart from clinical presentation and imaging techniques, cyst fluid analysis may be useful in the preoperative differential diagnosis of these patients, since detecting K-RAS mutations, carcinoembryonic antigen levels >400 ng/ml and CA19-9 >50,000 U/ml may indicate malignancy over a benign lesion, such as a pseudocyst.”
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes Doulamis, Ilias P. et al. International Journal of Surgery , Volume 35 , 76 - 82 - ” In the present study, median patient age at diagnosis was 67 years and the majority was white females. Findings from literature review indicated a similar age range (29–89 years), but over a decade younger with a mean age of 54.3 years. Only two studies reported data regarding patient race; in both studies white race dominated (87.6%). It should be noted that, before 2000, small case-series advocated that female predominance is less common in pancreatic mucinous cystadenocarcinoma compared with benign cystic tumors and some studies even found higher prevalence in males.”
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes Doulamis, Ilias P. et al. International Journal of Surgery , Volume 35 , 76 - 82 - ” In the present study, median patient age at diagnosis was 67 years and the majority was white females. Findings from literature review indicated a similar age range (29–89 years), but over a decade younger with a mean age of 54.3 years. Only two studies reported data regarding patient race; in both studies white race dominated (87.6%). It should be noted that, before 2000, small case-series advocated that female predominance is less common in pancreatic mucinous cystadenocarcinoma compared with benign cystic tumors and some studies even found higher prevalence in males .With regard to tumor location, body/tail were the most frequently affected sites both in the SEER analysis (45.6%) and in accordance to literature, despite outdated reports implicating the head of the pancreas as the most common MCAC site.”
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes Doulamis, Ilias P. et al. International Journal of Surgery , Volume 35 , 76 - 82 - ” All in all, the prognosis of resectable MCAC seems to be significantly more favorable compared to pancreatic ductal adenocarcinoma, and inoperability is associated with very poor outcomes. To the best of our knowledge this is the largest population-based study specifically dedicated to the epidemiology and outcomes of patients with pancreatic mucinous cystadenocarcinomas. The major strength of our study is that it limits publication bias, which traditionally hinders the applicability of results generated by secondary research papers. It should be noted that 66.7% of the SEER cases were diagnosed after 2000, whereas most of the studies identified were published before 2000 and mainly consisted of small case series (11–78 patients).”
Pancreatic mucinous cystadenocarcinoma: Epidemiology and outcomes Doulamis, Ilias P. et al. International Journal of Surgery , Volume 35 , 76 - 82