Six weeks after an episode of severe acute pancreatitis, a 40-year-old man has a persistent epigastric mass. CT shows a 7 cm well-defined cyst compressing the stomach. Fluid aspirated shows very high amylase. The defining pathological feature that separates this lesion from a cystic neoplasm is:

• A Presence of a cuboidal epithelial lining producing mucin
• B Absence of an epithelial lining, with a fibrous and granulation tissue wall ✓
• C Communication with a dilated main pancreatic duct lined by dysplastic epithelium
• D Central stellate scar with microcystic spaces lined by glycogen-rich cells

Explanation

A pancreatic pseudocyst results from enzymatic digestion of necrotic pancreatic tissue and is enclosed only by granulation and fibrous tissue with no epithelial lining. This single feature distinguishes it from all cystic neoplasms. Option A describes mucinous cystic neoplasm, option C describes branch duct IPMN, and option D describes serous cystadenoma, all of which are true epithelial-lined neoplasms.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.