A 45 yrs female presents with recurrent epigastric abdominal pain and jaundice. USG shows clausters of cysts, cysts are having lobulated margins, in the head of pancreas. MR reveals a multicystic mass with a bunch of grapes appearance and a grossly dialated pancreatic duct. The most probable diagnosis is:
C i.e. (Intraductal papillary mucinous neoplasm (IPMN): (without any doubt) Bunch of grapes appearance with lobulated margins is highly suggestive (and characteristic) of serous cystadenoma. It is actually a cystic tumor with multiple tiny cyst (>6 in number))measuring < 2cm in size with a high stromal content seperated by thin septa lined by epithelial cell. Therefore these lesions appear solid owing to the compact arrangement of multiple small cyst forming myriad of (many) interfaces and produce finely lobulated microcystic lesion with internal septation producing classic cluster of grapes appearance. In mucinous cystadema the cysts are mostly large (average 10cm) unilocular or multilocular (<6) with a less prominent lobulation. Intraductal papillary mucinous tumor (IPMT) produce cystic appearance b/o dilated pancreatic ductal system distal to IPMT, so it is more like a distended ductal system covered by normal pancreatic parenchyma. So in mucinous cystadenoma cysts are much larger & lesser, whereas in IPMT there is no true microcystic pattern to produce almost solid bunch of grape appearance. Now lets focus on grossly dilated ductal'system which indicates total or near total ductal obstruction. All of them can 1/t ductal obstruction & gross dilatation the only difference is that it is almost always early, intraluminal with out obstructive ductal stricture, intense and communicating (i.e. cyst communicates with pancreatic duct) in IPMT, whereas it is b/o compression of duct from outside, in mucinous & serous cystadenoma (in which case it is gradual & non communicating). Serous cystodenoma occurs in females over age of 60 years (range 35-85yrs; F:M = 2/4 : 1) whereas IPMN mainly occurs in males between 60 & 80 years. All of these can cause jaundice, abdominal pain when present in head of pancreas.
Serous cystadenoma
Mucinous cystadenoma
Intraductal papillary mucinous neoplasm (IPMN)
Solid pseudopapillary epithelil neoplasm