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Meaning Of CT Scan Results Showing Peripancreatic Lymph Node Non-specific?

Posted on Mon, 3 Mar 2014

Question: I had a ct scan and I have a 1.6 x 1.2 cm peripancreatic lymph node that it's non specific. Please explain.

Answered by Dr. Dr. Ivan Romich (41 minutes later)

Brief Answer: Hi and welcome to XXXXXXX Detailed Answer: Thanks for the query. what is the exact reason why ct was performed? If there is no some other intraabdominal patology seen on ct then this finding shouldnt concern you. This is just mildly enlarged lymph node which is usually seen as reaction to any infectious agent or it has no significance at all. If nodes are enlarged more than 2cm and there is intraaabdominal tumor then it may indicate malignant disease. Also,if you are worried about lymphoma,it rarely starts at this place and there would be some other signs and symptoms. Wish you good health. Feel free to ask. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (25 hours later)

My CT scan says My common bile duct is non dilated. Is that good and is it usually very accurate?

Answered by Dr. Dr. Ivan Romich (2 hours later)

Brief Answer: hi Detailed Answer: This is good. it means that there is no obstruction of biliary tree so your liver function is not damaged. CT scan is very accurate in defining biliary system and pancreas. CT sensitivity is almost 95% in these pathologies.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (44 hours later)

I had abdominal testing with ultra sound and a ct scan. They both showed a normal pancreas. But the ct can did show a incidental low density mass in the left adrenal gland and suggested I get a MRI to make a determination. The radiologist believes it is a benign adenoma. My gastreologist feels I should do the MRI. He also wrote the prescription that includes another view of the pancreas. Before the ct scan I was on pins and needles, and was very relieved when it came back normal. Now another test and more worry. He also added a MRCI. What can I expect?

Answered by Dr. Dr. Ivan Romich (33 hours later)

Brief Answer: hi Detailed Answer: This low density mass in most cases indicate adenoma and you shouldnt be concerned about it. i dont think that MRI is neccesary but you can do it if you ll feel better. MRCI will evaluate biliary ducts and it is done if there is biliary tract obstruction suspected. It can be caused by stone or tumor. But if you dont have jaundice,weight loss, pain in right abdomen then i dont expect that anything will be found.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (11 hours later)

My endoscopy determined I have mild gastritis, but my concern now is possible billiary obstruction. I have a little weight loss and my appetite is not as good as usual and some knawing pain in the upper right quadrant.No jaundice. I had an ultra sound and a ct scan that shows no obstruction. How likely is it that a MRCI could find something and would it be small enough to treat?

Answered by Dr. Dr. Ivan Romich (11 minutes later)

Brief Answer: hi Detailed Answer: this is not likely. If you would have symptomatic biliary obstruction then obstruction would be seen on regular CT scan and there would be elveated bilirubin levels. So I dont think your symptoms are related to this issue. MRCI is very sensitive and it can reveal even minor lesions in biliary system,and even if there will be some lesion which is seen only on MRCI then it would be coincidence and this is not something that could cause weight loss and apetite changes. Also, if there will be the worst scenario, which means that there is malignant tumor of biliary duct, then it will be operable and you can be very happy to find it in early stage. But I really think that your symptoms are more likely caused by gastritis, gallbaldder stone,IBD or some other more common causes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (8 hours later)

I had a MRI and the report indicated I had 2 super small lesions in the pancreas that the ct scan Did not pick up. The radiologist indicated that we maybe should get another MRI in about 6 months to monitor. My GI is not familiar with these lesions. Do you have any idea what they could be?

Answered by Dr. Dr. Ivan Romich (18 hours later)

Brief Answer: Hi Detailed Answer: It is hard to say what these lesions are. most commonly this is just pancreatic cyst,fibrous tissue or adenoma and it requires just radiologic follow up as your radiologist recommended. if there is sign of rapid grow or malignancy then surgical procedure is neccesary. The only relation between such small lesions na dyour symptoms can be if this is NET(neuroendocrine tumors) but these have some other radiologic features.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (1 hour later)

Here is how the report reads. Pancreatic ductal anatomy appears conventional. There is T2 hyper intense focus seen within the pancreatic head on 11,6,12,37. This measures approximately 1.3cm in the longest dimension. There is likely communication with the main pancreatic duct. There is no evidence of abnormal enhancement post contrast administration. The othe lesion is 1.cm at the neck with the same enhancement language. The radiologist indicates these are side branch IPMN. He recommends follow up in 6 to 12 months. Please comment.

Answered by Dr. Dr. Ivan Romich (26 hours later)

Brief Answer: Hi Detailed Answer: Even if this is side branch IPMN,if this is less than 3 cm and there is no symptom such as jaundice,then no surgical treatment is recommended. It should be just followed up in a year and if there is rapid grow,size more than 3cm or sign of infiltration,then surgery must be performed. Such tumors rarely become malignant and in most people it is asymptomatic lifetime. So there is no need for preventional resection. You have small lesion and I doubt that it can be cause of your symptoms. It still can be just part of chronic pancreatitis,adenoma or cyst. You can do ERCP or MRCP but I dont think that it will show something more. Your apetite loss can be caused by stomach issue,or some other not GI related issues such as endocrinologic or psychosomatic. Biliary obstruction would lead to bilirubin elevation and dilatation of biliary ducts and you dont have any of these.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (4 hours later)

Dr. Romic, your answers are very helpful and I really think my small lesions in the pancreas are not causing my symptoms, I do know I have mild gastritis, and I assume this is the reason I have symptoms. But, I have tried Nexium and sulcrafate and the stomach pain continues to linger. What kind of a regiment would you suggest I follow?

Answered by Dr. Dr. Ivan Romich (2 days later)

Brief Answer: Hi Detailed Answer: If you didnt already, you should do gastroscopy and stomach biopsy to see is there h.pylori infection which should be eradicated then. Also colonoscopy may show large bowel causes of your pain. Secondly,there can be some bowel disorder so bowel barium exam could reveal is there any kind of obstruction at the level of small intestines. If everything is fine then this is probably functional disorder such as IBD,food allergy or psychosomatic effect. I still dont think that this pancreratic lesion could cause any symptoms.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (15 hours later)

I had an endoscopy several weeks ago and was diagnosed with mild gastritis. I also met with a pancreatic specialist and since I have two small lesions, about 1cm each, she wants a follow up in 6 months with a ct scan. She said if the lesions grow to 3cm, they will need to be tested and removed. How likely are these cysts to grow to a point that surgery would be required?

Answered by Dr. Dr. Ivan Romich (20 hours later)

Brief Answer: Hi Detailed Answer: Not likely.Probably those lesions were growing to 1cm for many years,even decades. So it is not likely that it will grow to 3cm and usually it dont. But it is good to know that there is suspicius pancreatic cyst so that it can be properly followed up and any surprise can be prevented on time. If there will be fast growing or features of malignancy,it will be removed completely with no consequances.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (2 days later)

Hopefully getting near to the end of questions. I indicated earlier that on my ct scan they discovered 1.6 lymph node on the outside of the pancreas. The ct scan showed a normal pancreas and the radiologist had no comment. My pancreatic doctor said the lymph node was a little large and I think this is why they wanted a MRCP for the pancreas. As noted, they did find two side branch IPMN 1cm lesions in the pancreas. Does this in anyway indicate my cysts could be malignant? My doctor did not want to biopsy the lesions because they are too small. 6 months they will be evaluated.

Answered by Dr. Dr. Ivan Romich (22 hours later)

Brief Answer: Hi Detailed Answer: Yes,this is slightly enlarged lymph node,but it isnt indicating malignancy. it can be normally seen during routine ct scan. Even if this is IPMN,which I doubt, it is practically impossible that such small tumor could give lymph node metastases. Lymph nodes can be enlarged as reaction to any systemic,abdominal or respiratory infection,also in chronic pancreatitis. Biopsy of such small lesion is never done. It would be too risky, and too difficult to "mess" with pancreas biopsy in this case. In clinical practice, such lesions should be followed up and possible malignant alteration wont be missed. MRCP wont reveal something new abiut this lymph node,but it will show biliary and panceratic duct more detailed.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (43 minutes later)

Dr. Romic, Why do you think these small lesions are not IPMN?

Answered by Dr. Dr. Ivan Romich (2 hours later)

Brief Answer: hi Detailed Answer: On CT, a side-branch IPMN typically appears as a hypodense nonenhancing pleomorphic lesion. MRI would have some other features: usually there is cluster of small cysts with lobulated margins and septations. Of course,all these features are difficult to determine in such small lesions. However,whatever it is, it is not likely that it can be symptomatic. Surgery or biopsy is definitely not an option and you need follow up as recommended. MRCP will show is there communication with pancreatic duct,but we already know it.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (49 minutes later)

Recap. I have two small 1cm lesions in my pancreas. Possibly side branch IPMN. Possibly not. I have scheduled follow up in 6 months. We feel these lesions are not causing symptoms, and my pancreatic specialist agrees. You feel these cysts could have been here for a long time and many of these cysts show very slow growth. I do feel these these lesions will not get out of hand, because of the pending supervision, but I have not had peace since these cysts were found and your assessment of this condition has been very helpful. Final question, is it possible these things will never grow to the point a resection would be needed?

Answered by Dr. Dr. Ivan Romich (16 hours later)

Brief Answer: hi Detailed Answer: yes. you ve figured it out,this is exactly what I think and this is all you need to know about IPMN. If you didnt have MRI,you wouldnt probably never discover that you have it,but it is good to know it. Surgery is always the last option because majority of SB-IPMNs wont cause symptoms and wont progress to invasive cancer. Also sensitive imaging tests are very available today, so IPMN can be followed up and malignancy will be detected in early phase. So you can expect that you wont need surgery. Statistically, it grows to 3cm in next 5 years in 30% of patients. You should have peace of mind and hope that you are not in these 30%. At the end, even if surgery will be necessary,I dont see some problem for you. In most centres pancreatic resection can be performed safely and recovery is fast.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar