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Mucinous ductal ectasia of the pancreas
R K McDowell1, G S Gazelle, B L Murphy
1Radiology Associates of Clearwater, FL, USA.
Purpose:
Pancreatic mucinous ductal ectasia (MDE) is a recently described and poorly understood disorder, with few cases reported in the imaging literature. We undertook this study to describe the spectrum of CT and pancreatographic findings of MDE and to investigate the incidence of associated pancreatic malignancy.
Method:
The medical records, CT scans, and pancreatograms of 12 consecutive patients with pathologically proven MDE were retrospectively reviewed. There were nine men and three women, ranging in age from 37 to 72 years (mean 59 years).
Results:
Focal lesions involved primarily the uncinate (two patients) and head (eight patients) by CT imaging. The entire gland was involved in two patients. CT findings were variable and included focal pancreatic enlargement, a low attenuation or cystic mass, low attenuation of the entire gland, or marked ductal dilatation. Pancreatographic findings were more consistent, showing ductal dilatation with or without intraluminal filling defects, obstruction, or displacement. In all cases, findings at endoscopy were felt to be characteristic, with ductal dilatation, filling defects, or abundant mucus seen upon cannulation of the pancreatic duct. Carcinoma-in-situ was present in six cases, cellular atypia without malignancy in two, and in three cases the lesions were histologically benign. One case demonstrated invasive adenocarcinoma. No finding or group of findings on CT or pancreatography permitted differentiation between benign and malignant lesions.
Conclusion:
MDE can present with a variety of appearances on CT, none of which is diagnostic. Pancreatography can be diagnostic if dilatation and intraluminal filling defects are seen. Carcinoma-in-situ, invasive adenocarcinoma, or cellular atypia is present in approximately 75%, but cannot be accurately diagnosed prospectively.
Insights
Pancreatic mucinous ductal ectasia (MDE) presents variably on CT scans. Pancreatography aids diagnosis, but differentiating benign from malignant MDE lesions remains challenging, with high rates of associated malignancy.
Area of Science:
- Gastroenterology
- Radiology
- Pathology
Background:
- Pancreatic mucinous ductal ectasia (MDE) is an uncommon and poorly understood pancreatic disorder.
- Few cases have been reported in medical imaging literature, necessitating further characterization.
Purpose of the Study:
- To delineate the spectrum of CT and pancreatographic findings associated with MDE.
- To evaluate the incidence of pancreatic malignancy in patients with MDE.
Main Methods:
- Retrospective review of medical records, CT scans, and pancreatograms from 12 patients with pathologically confirmed MDE.
- Analysis of patient demographics, lesion location, and imaging characteristics.
Main Results:
- CT findings were diverse, including focal enlargement, low attenuation masses, diffuse gland involvement, and ductal dilatation.
- Pancreatography revealed consistent ductal dilatation, filling defects, obstruction, or displacement.
- Histopathology showed carcinoma-in-situ in 6 cases, cellular atypia in 2, benign lesions in 3, and invasive adenocarcinoma in 1 case.
- No imaging findings reliably differentiated benign from malignant MDE lesions.
Conclusions:
- MDE exhibits varied CT appearances, none definitively diagnostic.
- Pancreatography is more diagnostic, especially when showing ductal dilatation and filling defects.
- Approximately 75% of MDE cases harbor malignancy (carcinoma-in-situ, invasive adenocarcinoma, or atypia), which cannot be prospectively diagnosed via imaging.