Large-duct type pancreatic ductal adenocarcinoma (PDA) is a rare morphologic variant forming large duct elements. This case report, to our knowledge, is the first report of a large-duct type PDA with a "honeycomb" appearance resembling a serous cystic neoplasm (SCN) on CT and MRI. The patient is an 82-year-old woman who presented with upper abdominal pain. Dynamic contrast-enhanced CT revealed a multilocular cyst with honeycomb loculi, in which the cyst walls showed gradual enhancement. On T2-weighted MRI, the mass displayed inhomogeneous hyperintensity characterized by a honeycomb appearance with irregular and thick hypointense cyst walls. The patient underwent distal pancreatectomy; histopathological diagnosis was large-duct type PDA. Although the imaging features of large-duct type PDA may resemble those of SCN, this distinction between PDA and SCN is important because the treatment options are very different.
Keywords: CE-CT, Contrast-enhanced CT; DWI, diffusion-weighted imaging; Honeycomb appearance; Irregular cyst walls; Large-duct type; MPD, main pancreatic duct; MRI; PDA, pancreatic ductal adenocarcinoma; Pancreatic ductal adenocarcinoma; SCN, serous cystic neoplasm.
© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.