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Self-Assessment Questions

Gastroenterology

Cystic Lesions of the Pancreas: Review Questions

Douglas G. Adler, MD, and Randall K. Pearson, MD, FACG

Dr. Adler is an Advanced Endoscopy Fellow, Division of Gastroenterology and Hepatology, Mayo Clinic; and Dr. Pearson is a Professor of Medicine, Mayo Medical School, Rochester, MN.


Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.

A 68-year-old woman who has had mild abdominal pain for 8 years visits her physician for evaluation. The patient has a concomitant history of multivessel coronary artery disease and severe chronic obstructive pulmonary disease. A computed tomography (CT) scan of the abdomen reveals a 6-cm lesion containing many small cysts in the distal body of the pancreas with a central stellate scar. Endoscopic ultrasonography confirms the presence of a complex mass consisting of multiple small cysts, none of which is larger than 2 cm. There is no evidence of local invasion or adenopathy.

1. Which of the following types of lesions does the patient most likely have?
  1. Intraductal papillary mucinous tumor
  2. Mucinous cystadenocarcinoma
  3. Mucinous cystadenoma
  4. Pancreatic pseudocyst
  5. Serous cystadenoma
Click here to compare your answer.


2. Which of the following is the best course of action at this time?

  1. Distal pancreatectomy with splenectomy
  2. Distal pancreatectomy without splenectomy
  3. Endoscopic drainage of the lesion
  4. Pancreatoduodenectomy (Whipple procedure)
  5. Observation
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3. A 52-year-old woman with a 3-month history of moderate abdominal pain has serum amylase and lipase levels that are twice the upper limit of normal. A CT scan of the abdomen reveals an 8-cm mass in the tail of the pancreas that contains several 2- to 3-cm cysts with irregular septations and does not involve the pancreatic duct. Results of a fine-needle aspiration guided by endoscopic ultrasonography disclose the presence of mucus within the cyst. Which of the following is the most appropriate next step in the treatment of this patient?

  1. Distal pancreatectomy with splenectomy
  2. Endoscopic drainage of the lesion
  3. Pancreatoduodenectomy (Whipple procedure)
  4. Surgical enucleation of the tumor
  5. Observation
Click here to compare your answer.


4. A 23-year-old man has an episode of severe acute pancreatitis associated with gallstones requiring a 10-day hospitalization and nasojejunal feedings. One month after discharge, he is feeling well and returns for a follow-up visit. He has some abdominal fullness but no other symptoms. A CT scan reveals residual inflammation in the pancreas with a 7-cm thin-walled cystic lesion arising from the pancreatic head, partially compressing the patient’s duodenum. What type of lesion does the patient most likely have?
  1. Ampullary cancer
  2. Duodenal duplication cyst
  3. Pancreatic adenocarcinoma with cystic transformation
  4. Pancreatic pseudocyst
  5. Serous cystadenoma
Click here to compare your answer.


5. A 53-year-old man has had 2 episodes of acute pancreatitis without clear cause in 1 year. He undergoes endoscopic retrograde cholangiopancreatography; results indicate a normal bile duct and no stones. His papilla appears to be bulging and extruding mucus into the duodenal lumen, and his pancreatic duct is dilated. A CT scan shows a 3-cm cystic mass in the pancreatic head arising from a side branch of the main pancreatic duct. What type of lesion does the patient most likely have?

  1. Cholangiocarcinoma
  2. Intraductal papillary mucinous tumor
  3. Mucinous cystadenocarcinoma
  4. Pancreatic adenocarcinoma
  5. Pancreatic pseudocyst
Click here to compare your answer.
 

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