Histologic and Imaging Features of Mural Nodules in Mucinous Pancreatic Cysts Ning Zhong, Lizhi Zhang, Naoki Takahashi, Vladislav Shalmiyev, Marcia Irene.

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Histologic and Imaging Features of Mural Nodules in Mucinous Pancreatic Cysts Ning Zhong, Lizhi Zhang, Naoki Takahashi, Vladislav Shalmiyev, Marcia Irene Canto, Jonathan E. Clain, John C. Deutsch, John DeWitt, Mohamad A. Eloubeidi, Ferga C. Gleeson, Michael J. Levy, Shawn Mallery, Massimo Raimondo, Elizabeth Rajan, Tyler Stevens, Mark Topazian Clinical Gastroenterology and Hepatology Volume 10, Issue 2, Pages 192-198.e2 (February 2012) DOI: 10.1016/j.cgh.2011.09.029 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Histologic criteria of epithelial mural nodules in BD-IPMN and MCN. (A) Nodule is grossly visible on the histology slide (original magnification, 1×). (B) A stalk (arrow) is present connecting to the cyst wall, with glands on both sides of the stalk (IPMN only) (original magnification, 2×). (C) Detached fragments of complex papillary mucosa are present, with stalk (arrow) or fibrotic cores (IPMN only) (original magnification, 2×). (D) Intracystic nonpapillary excrescences (arrow) with broad bases connecting to the cystic wall, which also contain ovarian-type stroma and entrapped glands instead of fibrovascular cores (MCN only) (original magnification, 2×). Clinical Gastroenterology and Hepatology 2012 10, 192-198.e2DOI: (10.1016/j.cgh.2011.09.029) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 Pathology and imaging review of 57 consecutive resected mucinous pancreatic cystic neoplasms. EN, epithelial nodule by histology review; “malignancy” includes both HGD and invasive carcinoma. Clinical Gastroenterology and Hepatology 2012 10, 192-198.e2DOI: (10.1016/j.cgh.2011.09.029) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 Epithelial nodules detected by EUS and CT. (A) The maximum diameter of epithelial nodules detected and missed by EUS and CT. (B) A 2-mm epithelial nodule missed by EUS (original magnification, 2×). Clinical Gastroenterology and Hepatology 2012 10, 192-198.e2DOI: (10.1016/j.cgh.2011.09.029) Copyright © 2012 AGA Institute Terms and Conditions

Figure 4 EUS features of mucus. (A, B) Two cases of mucus with typical features: hypoechoic compared with adjacent soft tissue, smooth-edged, with a hyperechoic rim. (C) Mucus with only 2 features: hypoechoic compared with adjacent soft tissue, partial hyperechoic rim. (D) Histology of the case in panel C shows acellular mucus. (E, F) Mucus with 3 typical features, which moved after change of patient position (F). Arrows indicate mucus. Clinical Gastroenterology and Hepatology 2012 10, 192-198.e2DOI: (10.1016/j.cgh.2011.09.029) Copyright © 2012 AGA Institute Terms and Conditions

Figure 5 EUS features of mural nodules. EUS (A, C, E) and matching histology (B, D, F) from 3 cases. Epithelial mural nodules are usually isoechoic or hyperechoic compared with adjacent soft tissue, are not smooth-edged, and do not have a hyperechoic rim. Arrows indicate epithelial nodules. Clinical Gastroenterology and Hepatology 2012 10, 192-198.e2DOI: (10.1016/j.cgh.2011.09.029) Copyright © 2012 AGA Institute Terms and Conditions