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This is an contrast enhanced EUS of a 5cm pancreatic mass together with the doppler (arterial and venous phases) and elastography images
WHAT IS THE MOST LIKELY DIAGNOSIS?
explanation
This the typical appearance of a serous cystic neoplasm (formerly called serous cystic adenomas) situated in the tail of the pancreas. The natural history of these lesions is poorly known.
The typical appearances includes:
A multinational study of 2622 patients reported that these lesions are more common in women (1:4 ratio), avg age 58 yrs. In this cohort the size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Only 3 serous cystadenocarcinomas were recorded and therefore a conservative approach was advocated. Most operations were carried out because of uncertainty over the diagnosis. Some would also consider offering surgery for patient with symptoms. However, in the above series only 9% of patients presented pancreaticobiliary symptoms directly related to the lesion. Because 10 patients died following surgery every effort must be made to make the diagnosis with the aid of CT, MRI and EUS and FNA. Low CEA levels with have an excellent specificity for diagnosis of a 'SCN' but can also be found in IPMNs and in neuroendocrine tumours.
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