PMC4769611_01
The segmental cystic dilation of the main pancreatic duct in the abdominal US (A, B) on the body of the pancreas, bordering the lobule, associated with the dilated pancreatic duct (asterisks); solid components projecting into the lumen in the periphery (long arrow). No flow was observed within the lesion in colored Doppler US (C). The main pancreatic duct is 4.8 mm in width (arrow head) in the US (D). The sub-branch dilation seen in the MR cannot be distinguished.
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fig1
In the US examination, it was determined that there was segmental cystic dilation causing lobulated contour of the size of 55 x 45 mm at the pancreatic duct on the body of the pancreas, associated with the dilated pancreatic duct, with thick septa in the periphery and solid nodular components that projected into the lumen, the largest of which was 13 x 12 mm in size; and in which no color fills or spectral flow forms were observed in colored Doppler US (Fig. 1). The pancreatic duct showed dilation that was up to 4.8 mm (Fig. 1D).
The segmental cystic dilation of the main pancreatic duct on the body of the pancreas (asterisk), bordering the lobule in axial T2W (A) and axial contrasted T1W (B) series, with smooth borders, associated with the dilated pancreatic duct. There are sub-branch dilations (short arrow) associated with the main pancreatic duct (A-C). There are contrasted solid nodular components (long arrow) and septa in the T1W (D) series after the contrast administration, in the periphery projecting into the lumen.
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fig2
Segmental cystic dilation had solid nodular components in its periphery, projecting into the lumen, the largest of which was 13 x 12 mm in size; and containing septa, showing hypointense signal properties in T1-weighted (W) series and showing clear hyperintense signal properties in T2W series, whose nodular solid components were contrasted after paramagnetic contrast matter application (Fig. 2, Fig. 3).
There is dilation in the proximal and distal main pancreatic duct and the sub-branches of the segmental cystic dilation in MRCP.
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fig4
There were filling defects representing solid components in the cystic bulk lesion periphery (Fig. 4).
Segmental cystic dilation in the main pancreatic ductus lumen, erosion in the mucosa, ulcer bleeding, and mucosal projections.
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fig5
In macroscopic examination, dilation in pancreas main ducti and in accessory ductus lumens, segmental cystic dilation of the size of 8 x 4.5 x 3 cm in the main ductus structure and villiform mucosal projections were detected (Fig. 5).
The papillary tumoral formation (H.E. x 40), which stretches to the ductus lumen (A), showing villous structure in some places. Papillary structures (H.E. x 100) with pseudostratified columnar cells (B). In some places, the intracytoplasmic mucin content is clear. H. E., hematoxylin eosin.
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fig6
No areas were observed in the sections that would make us consider invasion (Fig. 6).
PMC4769611_02
The gallbladder is hydropic in axial T2W (A, B) series, and the choledoch seems dilated (thick white arrow). The intrahepatic bile ducts have become clear in the central area. Neighboring hyperintense cysts in the pancreas are visible. These cysts are in bigger size in the uncinated process. The cysts are observed in hypointense form (asterisks) in axial T1W (C) series. In contrasted T1W (D) series, there is not an enhanced solid component (asterisks). In axial T1W (E) and contrasted T1W (F) series, many hypointense cysts that are associated with the pancreatic duct are visible and are smaller (thin white arrow) than those located in the uncinated process in the pancreas body and tail part and do not have solid component.
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fig7
There were no contrast enhanced solid components within the cysts (Fig. 7).
In MRCP (A, B), cysts characterized with hyperintense signal features in various sizes along the pancreas are visible. The pancreatic duct is of normal width (white arrow). The choledoch is dilated, and the gallbladder is observed in distention. The cyst has exerted pressure on the choledoch (white arrow).
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fig8
The gallbladder was distended, and the intrahepatic bile ducts were in the central area and were dilated in both lobes secondary to the pressure of the cysts (Fig. 8).