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Background Intraductal papillary mucinous neoplasms of the pancreas are increasingly diagnosed. Due to their malignant potential, greater understanding of their nature is required. Aims Define risk factors for malignancy in intraductal papillary mucinous neoplasms. Methods An international, multicentre study was performed in Europe and the United States. Clinical databases were reviewed for patients with intraductal papillary mucinous neoplasms diagnosis. Results Of 1126 patients, 84 were diagnosed with invasive carcinoma/high-grade dysplasia and were compared to the rest of the cohort. Multivariate logistic analysis showed a statistically significant association between cancer/high-grade dysplasia and the variables smoking history (OR 1.9, 95% CI [1.1–3.1]), body mass index (OR 1.1, 95% CI [1–1.1]), symptoms (OR 3.4, 95% CI [1.9–6]), jaundice (OR 0.1, 95% CI [0–0.3]), and steatorrhea (OR 0.3, 95% CI [0.1–0.8]). Univariate analysis showed no association between malignancy and the cyst number/location ( p = 0.3 and p = 0.5, respectively) although a strong association was shown for cyst size ( p < 0.001). The presence and size of nodules ( p < 0.01) and main duct involvement ( p < 0.001) were also strongly related with malignancy. Conclusion The presence of jaundice and steatorrhea, smoking, high body mass index, and imaging features such as cyst size, main duct involvement, and the presence and size of mural nodules are associated with high-grade neoplasia in intraductal papillary mucinous neoplasms. [ABSTRACT FROM AUTHOR]

Background Solid organ transplant recipients have an increased risk of cancer due to immunosuppressive therapy. Pancreatic cystic lesions are increasingly being detected, some with malignant potential. We aimed to determine the prevalence of these lesions and describe their clinical course in these patients. Methods We identified the presence of pancreatic cystic lesions in a retrospective cohort of 3188 consecutive solid organ transplant recipients from 2000 to 2013 and compared lesion characteristics at initial and follow-up imaging, when available. Results Lesion prevalence was 11.4% (365/3188), and increased with age. Median diameter of the largest lesions was 7 mm (range: 1–31 mm). We noted worrisome features in two patients (0.54%) at the time of cyst diagnosis. Of 155 patients who underwent follow-up imaging, the cysts size remained stable in 80%, increased in 16%, and decreased in 4%. Two patients (1.3%) developed features concerning for cancer. One underwent pancreatic surgery, and pathology confirmed the presence of high-grade dysplasia. The other continued with conservative management due to multiple comorbidities. Conclusions Pancreatic cystic lesions are common in solid organ transplant recipients. In lesions without high-risk features, the development of features worrisome for cancer is rare. These lesions can be managed conservatively, and their presence should not affect transplant eligibility. [ABSTRACT FROM AUTHOR]

Background & Aims Increasingly, pancreatic cysts are discovered incidentally in patients undergoing cross-sectional imaging for nonpancreatic reasons. It is unclear whether this increase is caused by improved detection by progressively more sophisticated cross-sectional imaging techniques or by a true increase in prevalence. We aimed to determine the prevalence of incidental pancreatic cysts in patients undergoing magnetic resonance imaging (MRI) for nonpancreatic indications on successive, increasingly sophisticated MRI systems. Also, we compared prevalence based on the demographic characteristics of the patients. Methods We collected data from MRIs performed at the Mayo Clinic in Florida during the sample months of January and February, from 2005 to 2014. Each patient’s clinical chart was reviewed in chronological order to include the first 50 MRIs of each year (500 total). Patients were excluded if they had pancreatic disease including cysts, pancreatic surgery, pancreatic symptoms, pancreatic indication for the imaging study, or previous abdominal MRIs. An expert pancreatic MRI radiologist reviewed each image, looking for incidental pancreatic cysts. Results Of the 500 patients analyzed, 208 patients (41.6%) were found to have an incidental cyst. A significant relationship was observed between pancreatic cysts and patient age ( P < .0001), diabetes mellitus ( P = .001), and nonpancreatic cancer ( P = .01), specifically nonmelanoma skin cancer ( P = .03) or hepatocellular carcinoma ( P = .02). The multivariable model showed a strong association between hardware and software versions and detection of cysts ( P < .0001); the old hardware detected pancreatic cysts in 30.3% of patients, whereas the newest hardware detected cysts in 56.3% of patients. Conclusions Based on an analysis of data collected from 2005 through 2014, newer versions of MRI hardware and software corresponded with higher numbers of pancreatic cysts detected. Older age, diabetes, and the presence of nonpancreatic cancer (specifically nonmelanoma skin cancer and hepatocarcinoma) were also associated with the presence of cysts. [ABSTRACT FROM AUTHOR]