Cystic and Papillary Epithelial Neoplasm of the Pancreas

Vivek David, MD
Stuart G Silverman, MD

Presentation

A 21-year-old black woman presented with vague abdominal pain and a palpable abdominal mass.

Imaging Findings

Abdominal CT

Computed tomography (CT) of the abdomen enhanced with intravenous contrast material shows a large, predominantly cystic mass arising from the pancreas [long arrow]. The wall is thick, and the mass contains solid elements [white arrowhead]. There is mass effect on adjacent structures, including bowel and inferior vena cava [black arrowhead] (arrows).

Differential Diagnosis

The differential diagnosis for this mass includes cystic and papillary neoplasm of the pancreas, mucinous cystic neoplasm, nonfunctioning islet cell tumor, and infected pseudocyst. Given the patient's age, race, and lack of history of pancreatitis, the most likely diagnosis is cystic and papillary epithelial neoplasm of the pancreas.

Diagnosis

Cystic and papillary epithelial neoplasm of the pancreas

Discussion

Cystic and papillary epithelial neoplasm of the pancreas is synonymous with solid and papillary epithelial neoplasm of the pancreas. This tumor is found most often in young black females at a mean age of 24 years (range 10-50 years). Cystic and papillary epithelial neoplasms typically arise from the tail of the pancreas but can arise from any portion of the pancreas. These tumors are usually large at diagnosis, with a mean diameter of 10 cm. The gross appearance is variable with tumors being solid, cystic, or mixed cystic and solid. Cystic and papillary epithelial neoplasm is a low-grade malignancy that is curable with surgical excision.

References

1. Friedman AC, Lichtenstein JE, Fishman EK, et al. Solid and papillary epithelial neoplasm of the pancreas. Radiology 1985; 154:333-337.

2. Gore RM, Levine MS, Laufer I. Textbook of gastrointestinal radiology. Philadelphia:WB Saunders, 1994: 2178-2179.

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