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Gross pathology: Main duct, branch duct, and mixed duct lesions, which determines surgical management. Main duct lesion is the segmental or diffuse dilatation of main pancreatic duct greater than 5 mm without other causes of obstruction. Meanwhile, branch duct lesion is the pancreatic cyst more than 5 mm that communicates with the main duct.
A Puestow procedure is indicated for the treatment of symptomatic chronic pancreatitis patients with pancreatic ductal obstruction and a dilated main pancreatic duct. The main pancreatic duct needs to be 6mm in diameter in the body of the pancreas for this procedure to be possible.
The pancreatic duct is generally regarded as abnormally enlarged if being over 3 mm in the head and 2 mm in the body or tail on CT scan. [9] Pancreatic duct or parts of pancreatic duct can be demonstrated on ultrasound in 75 to 85% of people. [10] Pancreatic ductal carcinoma is a common form of pancreatic cancer.
A pancreatic tumor is an abnormal growth in the pancreas. [1] In adults, almost 90% are pancreatic cancer and a few are benign. [1] Pancreatic tumors are rare in children. [1] Classification is based on cellular differentiation (ductal, acinar, neuroendocrine, other) and gross appearance (intraductal, cystic, solid). [1]
Cyst size greater than 3 cm, main pancreatic duct dilation of 5-10 mm, or a change in caliber or a narrowing of the main pancreatic duct with atrophy of the duct distally, presence of lymph node swelling, thickened or enhancing cyst walls, or an increase in cyst size over a year are considered intermediate risk imaging findings for cancer. [1]
Pancreatic mucinous cystic neoplasm (MCN) is a type of cystic lesion that occurs in the pancreas. Amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms. These lesions are benign, though there is a high rate of progression to cancer. As such, surgery should be pursued when feasible.