Elliot K. Fishman M.D.
Johns Hopkins Hospital

Click here to view this module as a video lecture.

”MCN occur almost exclusively in women and more commonly are found in the pancreatic tail. MCNs are oval or round and can show septations, cyst wall calcifications, enhancing capsules, and occasionally mural nodules. MCNs typically do not cause dilatation of the biliary or pancreatic ductal system but can be associated with distal pancreatic atrophy. They may be associated with lymphadenopathy but generally are not associated with peripancreatic fat infiltration or vascular involvement.”
Incidental Pancreatic Cysts on Cross-Sectional Imaging 
Shannon M. Navarro et al.
Radiol Clin N Am 59 (2021) 617–629

”Mucinous cystic neoplasms (MCN) of the pancreas are uncommon tumors that are nearly exclusively seen in middle-aged females. Although the vast majority of MCN are benign at time of diagnosis, they are considered pre-malignant lesions that may become dysplastic and malignant over time. To the best of our knowledge, the exact timeline for this progression is unknown. Needless to say, the ability to predict non-invasively the pathological subtype of MCN can have important advantages and implications. Firstly, biopsy of MCN is prone to sample bias as the epithelial lining of the cyst may be normal in one location but dysplastic or frankly malignant in others. Secondly, MCN with low-grade dysplasia may be treated conservatively with observation rather than surgery, especially in elderly patients with co- morbidities. Lastly, indications for high-grade dysplasia or carcinoma may trigger immediate surgical resection.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation 
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422

“In our series, all patients were women with a mean age of 45 years. Indeed, MCN is referred to as the ‘mother cyst’ and the previously reported distribution of MCN by gender is 89–99.7% female with a reported mean age at time of diagnosis of 48 years (range, 17–78 years). Presenting clinical signs and symptoms along with serologic biochemical values were also evaluated and correlated with pathology. Although in our cohort 75% of patients presented with at least one symptom, we did not identify any correlation between clinical symptoma- tology with the presence of high-grade dysplasia/carci- noma.”
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation 
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422

“Mucinous cystic neoplasms (MCN) of the pancreas are rare, low-grade tumors that occur predominantly in middle-aged women . They are reported to be maligant in about 6–27% of cases. Their most characteristic histopathological finding is the combination of mucin-producing epithelium supported by characteristic ovarian-like stroma that is not found in other pancreatic neoplasms. Furthermore, they usually are com- posed of large (> 2 cm) unilocular or multilocular macrocysts devoid of communication between the cyst and the pancreatic ductal system, and the presence of a fibrous capsule. All MCNs have the potential to transform into an invasive carcinoma, hence the necessity to resect them in their totality.” 
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation 
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422

Key distinguishing features:

• Smooth external contour
• Relatively thick enhancing wall
• Peripheral calcifications
• Thick septations or nodularity suggestive of malignancy

“Predictors of high-grade dysplasia (MCN) include size greater 8.5 cm.” 
Incidental Pancreatic Cysts on Cross-Sectional Imaging 
Shannon M. Navarro et al. 
Radiol Clin N Am 59 (2021) 617–629

”MCN size (> 8.5 cm) and volume are the only features on MDCT/MR imaging that correlate with high-grade dysplasia/carcinoma. The average growth rate for MCNs is slow at approximately 4 mm per year.” 
Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation 
Alejandro Garces-Descovich et al.
Abdom Radiol (2018) 43:1413–1422