Pancreatic pseudocyst or cancer - Follow up

Dr. Pho,

I wrote about my history and results of a CT scan a few days ago - the CT scan showed the presence of a hypodense lesion with signs of acute pancreatitis and an enlarged retroperitoneal lymph node (10 mm). The radiologist diagnosed the lesion as a pancreatic pseudocyst, but suggested further imaging to rule out cystic neoplasms. I went to a GI specialist at a leading University hospital, who looked at the images and concurred with the view of the radiologist. The GI physician recommended follow up imaging, both an MRCP and an EUS. I had an MRCP on Friday. The impression is as follows (I am paraphrasing the words): There is a 3 x 2 cm cystic lesion slightly superior to the body of the pancreas. There is no pancreatic ductal dilatation. There is a communication between the cyst and the pancreatic duct via a side branch. The pancreas is slightly enlarged, heterogenous in appearance with some restricted diffusion. Findings are suggestive of acute pancreatitis. The retroperitoneal lymph node is enlarged (1.3 x 1 cm). Final impression is strongly suggestive of a pancreatic pseudocyst.

Would this additional evidence from the MRCP help rule out cancer? Or, do I have to wait for the EUS for conclusive proof?

[Kevin Pho, MD]

Yes, the MRCP further makes it more probably that this is a pseudocyst.  With an imaging study, it is impossible to say 100% for sure.

I'm sure that the endoscopic ultrasound can help give even more certainty.  For peace of mind, it may be worthwhile proceeding with the test.  

But again, there will no way to be completely certain with imaging tests.  

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[pt563]

A related discussion, MRCP without dye was started.