Endoscopic ultrasound characteristics of mucinous cystic neoplasms of the pancreas

OBJECTIVE: Mucinous cystic neoplasms of the pancreas have a more favorable prognosis than ductal adenocarcinoma. Management of a subgroup, intraductal papillary-mucinous neoplasms, is controversial. Endoscopic ultrasound (EUS ) with fine-needle aspiration biopsy may emerge as the imaging modality of choice. There are few studies describing the EUS features of these tumors. METHODS: A total of 35 consecutive cases of cystic tumors of the pancreas w ith an established pathological diagnosis were analyzed for characteristic EUS features. RESULTS: Mucinous cystadenocarcinomas (n = 14) were more likely to be chara cterized by hypoechoic cystic/solid mass or complex cyst and were frequentl y associated with a dilated main pancreatic duct. Benign mucinous duct ecta sia (n = 6) were characterized by a dilated main pancreatic duct in conjunc tion with hyperechoic thickening of the duct wall. The two cases of intradu ctal mucinous hyperplasia additionally showed a hypoechoic mass. Intraducta l papillary carcinoma (n = 11) had features in common with mucinous cystade nocarcinoma but also had echogenic foci in the mass and intraductal hyperec hoic lesions. The two cases of microcystic cystadenoma showed either a mixe d hypoechoic solid/cystic mass or a complex cyst without the additional fea tures seen in mucinous cystadenocarcinoma. CONCLUSIONS: EUS features seem to exist that may help to differentiate cyst ic neoplasms from adenocarcinoma of the pancreas and, thus, to establish th e preoperative diagnosis of cystic tumors of the pancreas. (C) 2000 by Am. Cell. of Gastroenterology.