Cysts Pancreatic

Cholecystitis Lithiasis Choledochal cyst Pancreatitis Extraabdominal... 

A number of other proteins are now known to exhibit heterogeneity with respect to their carbohydrate content these include pig pancreatic ribonuclease,9 rabbit19 and human109-238 -yG immunoglobulin, ceruloplasmin,239 2-acetamido-2-deoxy-/3-D-glucosidase,240 and the blood-group substances from ovarian cysts.145,241... 

Pancreatic isozymes. In AP there is a significant increase in molecular forms P2 (approximately 91% of patients) and P3 (approximately 98% of patients) (P2, W5) as well as the presence of the isozyme P4, which does not appear in healthy controls (P2, N2). In the presence of a cyst, the P4 and P5 isozyme fractions are increased to >15% of total amylase activity. In the absence of a cyst, the P4 and P5 fractions make up <15% of total enzyme activity (T6). 

C02 is frequently the predominant duodenal gas and plays an important role in the physiology of cestodes in two ways (a) as a source of carbon atoms for metabolic functions via C02 fixation (Chapter 5) (b) as a trigger in the hatching of cyclophyllidean eggs (p. 192) or the excystment of larval cysts. Production of C02 results from the interaction of HC03 and H+, the latter being derived from secretions from the gut, biliary and pancreatic... 

On US, the pancreas with CF is characteristically of an echogenic texture secondary to fatty infiltration (Fig. 4.17). An enlarged pancreas may be seen initially with a subsequent atrophy later in life. Pancreatic duct dilatation and calcifications may be seen. Small cysts (anechoic areas) without vascular communication can be identified. Although a hyperechogenic pancreas is very typical of CF, some other diseases such as Schwachman-Diamond syndrome (exocrine pancreas insufficiency associated with bone marrow dysfunction, cyclic neutropenia, metaphyseal diastasis and growth retardation), hemosiderosis, chronic pancreatitis, and administration of steroids may also reveal this feature (Feigelson et al. 2000). 

CT may demonstrate an atrophic, fatty pancreas with heterogeneous attenuation. Areas of low attenuation will correspond to cysts, while areas of high attenuation will represent calcifications. Partial or total fatty and fibrous replacement are also commonly seen in these patients. There may be a correlation between the degree of fatty infiltration and the pancreatic exocrine dysfunction (Feigelson et al. 2000). 

Von Hippel-Lindau disease (VHL) is an autosomal dominant condition secondary to an alteration in a tumor suppressor gene on chromosome 3. It has incomplete penetrance and is characterized by hemangioblastomas in the retina, CNS, renal cell carcinoma, endolymphatic sac tumors, pheochro-mocytomas, papillary cystadenoma of the epididymis, angiomas of the liver and kidney, cysts of the liver, kidney and epididymis, and pulmonary arteriovenous shunts (Fig. 4.18a-c). In the pancreas, VHL may have multiple presentations, the most common being the presence of multiple small pancreatic cysts with calcifications in 40% of cases. Serous cystad-enomas, solid nonfunctional islet cell tumors, and adenocarcinoma are less common (Richard et al. 2004). 

US will reveal pancreatic cysts. On CT these cysts will have lower attenuation than the normal pancreatic parenchyma, and calcifications might be seen with unenhanced and enhanced CT (Choyke et al. 1990 Hough et al. 1994). 

Solitary congenital cysts maybe the least common cystic pancreatic lesion, with only 25 documented cases having been reported. Two additional patients... 

CT and US may demonstrate a low attenuating lesion or an anechoic defect typically located in the tail of the pancreas. This lesion can be unilocular or multilocular with multiple septae. The differential diagnosis includes cyst of renal origin, as well as choledochal, mesenteric, ovarian, and urachal cysts. ERCP and HIDA scans can be used to identify communication with the pancreatic duct or biliary tree. 

On the other hand> pancreatic pseudocysts represent the most common cystic masses in the pancreas. Pseudocysts are usually fluid collections with a thick wall that arise secondary to infections or trauma. Differentiation between a true cyst and a pseudocyst hy imaging is very difficult and can only be done by microscopic examination. 

MRCP is a very useful imaging tool used to identify possible etiologies of pancreatitis such as abnormal union of the pancreatobiliary junction, choledochal cyst, or pancreas divisum, in patients with unknown cause (Arcement et al. 2001 Hirohashi et al. 1997). 

Baker LL, Hartman GE, Northway WH (1990) Sonographic detection of congenital pancreatic cysts in the newborn report of a case and review of the literature. Pediatr Radiol 20 488-490... 

Moderately important lesions include conditions that do not require immediate treatment but would likely require investigation, recognition or treatment at a later time. Examples of moderate importance include calculi of various organs, previously known abdominal aneurysms, adrenal masses, pancreatic pseudo cysts, indeterminate cysts of various organs, uterine enlargement in post-menopausal women, and coronary artery calcifications. 

Fig. 30.7a-c. Serous cystadenoma a Axial CT demonstrates a multicystic mass in the pancreatic head and neck, which (b) is better seen on the coronal MPR (arrows), c However, the internal structure of the lesion with multiple, small cysts is better appreciated on the axial T2-weighted MR image... 

Fig. 30.8. Mucinous cystadenoma. The axial CT image shows a unilocular, thin-walled cyst. There was no history of pancreatitis in this patient, which renders diagnosis of a pseudocyst unlikely...

Fernandez-del Castillo C, Targarona J, Thayer SP, Rattner DVR Brugge WR, Warshaw AL (2003) Incidental pancreatic cysts clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 138 427 23 discussion, 433-424... 

David V, Kapel N, Dyard F, Henniges F. Pancreatic enzyme replacement therapy for young cystic fibrosis patients. J Cyst Fibres 2009 8 14-8. 

If renal cysts are found, cystic disease must be defined as unilateral or bilateral, localized or diffuse. Extrarenal manifestations such as hepatic or pancreatic cysts should be sought as well as evidence ofportal hypertension. CRF in unilateral cystic disease means renal hypo-dysplasia of the contralateral kidney even... 

Von Hippel-Lindau disease predisposes to the development of various tumors (hemangioblastomas of the neuraxis and retina, tumors of the membranous labyrinth, renal clear cell carcinomas or cysts, pheochromocytomas, pancreatic cysts or tumors, and epididymal cystadenomas). Renal cancer constitutes one of the main causes of death (Richard et al. 1998). Conversely, meta-analysis of cases of coincident tuberous sclerosis complex shows that the risk of malignancy is comparable with the normal population (Tello et al. 1998). 

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