MRI MRCP - Cyst (IPMN) - Newbie

Posted by chasenkw @chasenkw, Jul 12, 2022

So much gratitude for this group. Thank you !

My New GI doctor at University of Miami Healthcare ordered this test after I called needing colonoscopy. I discussed frequent abdominal pain, bloating, and more frequent bouts of pancreatitis. The findings:

Pancreas: Homogeneous parenchymal enhancement with a 0.6 cm cystic lesion in the pancreatic body, likely reflecting a small side branch IPMN. Otherwise, no lesions or ductal dilatation dilatation.

Should there be further testing of these finding? I have not heard from Dr yet. The test was last week, I obtained results from portal. “Is NO news GOOD news?”

Again, many many thanks.
Chase

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

Hi Mike,
Thank you for your reply. It sounds as tho you are monitoring and not considering a "preventative" Whipple as has been suggested for me. Had anyone offered you that option over monitoring? My CA19-9 had a value of less <2U/mL
Is that configuration of how your value reads?
I have been told that this IPMN in the head of the pancreas shows a 7mm dilation of the main duct? What if any is your duct dilated to?
Thanks in advance~ Bev

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@hopeful33250

Hello again, @frances007,

I'm always delighted to read your posts and hear how you are proactively tackling this problem. You've acquired some great helping relationships and they are definitely providing you with some direction. We all need those types of friendships!

I read that you are asking for a B6 lab, which was recommended by the rheumatologist. I'm guessing that there must be some question about absorption of vitamins? Do you know if this is the reason?

Yes, sometimes our friendships do change as our life situation does. Chronic illness can take a toll on the relationships that exist in our life. I have a feeling that you will find others to relate to and who can also support you during this time (and those whom you can support as well). Your new therapist seems to be one of those individuals.
As you've mentioned that you are an artist, are you aware that on Connect there is a discussion group on Art and Healing? In this discussion group, members post about their experiences using art as a healing tool.

You might especially enjoy seeing some posts by @jenniferhunter. Here is a link to two of her posts, https://connect.mayoclinic.org/comment/704654/ and
https://connect.mayoclinic.org/comment/608270/
There is also a post by @harriethodgson1 with her doodle art, https://connect.mayoclinic.org/comment/692015/
I would personally love to see a photo of one of your watercolors!

I look forward to hearing from you again. Will you continue to post about your search for an answer and any helpful results from the tests?

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I recently met with a rheumatologist who did not think that my bile duct dilation was caused by any autoimmune disease. Today I received a message that some tests showed negative findings of any autoimmune liver disease process. As you can imagine, this path I have been on has had so many twists that I feel like I need a new compass. I have lost 1/4 of my weight, have chronic diarrhea and nausea, as well as upper abdomen pain. I understand that the hepatologist I will see this March may be able to shed more light on my condition. I am an information junkie and the most frustrating part of all of this is that none of my current doctors are able to tell me what is going on or what has caused the bile duct dilations and cysts in my liver and pancreas. I am not feeling especially dismal, just frustrated with the lack of information or even theories. I want my doctor to throw me a clue, something to hang onto or look into so I have a better understanding of what has happened and is continuing to happen to my body.
I still greet each day with gratitude, continue to help others in my community, but the fear of the unknown has gotten a hold of me like tentacles and I cannot escape. I understand patience is a virtue, and I am my own worst enemy when it comes to being patient. I have been waiting patiently for nearly three years now, and know no more about my condition than when I was first told about it. Am I overreacting in some fashion? It is my nature to want answers, as we all want answers about our bodies. Not getting answers can be frustrating as well. We all know this feeling.
Maybe I will get my paints out tonight and paint a piece with a liver, something abstract. I have been baking all day, and this too has been therapeutic. I feel like I am channeling Martha Stewart with all this bread I have been baking. It really is quite good and easy. Bob's Redmill Artisian flour. No Knead Rustic Round. I have probably made 15 loaves in the past 2 months. For those who love bread but have never made it, it is an easy recipe and the bread is delicious.

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@frances007

I recently met with a rheumatologist who did not think that my bile duct dilation was caused by any autoimmune disease. Today I received a message that some tests showed negative findings of any autoimmune liver disease process. As you can imagine, this path I have been on has had so many twists that I feel like I need a new compass. I have lost 1/4 of my weight, have chronic diarrhea and nausea, as well as upper abdomen pain. I understand that the hepatologist I will see this March may be able to shed more light on my condition. I am an information junkie and the most frustrating part of all of this is that none of my current doctors are able to tell me what is going on or what has caused the bile duct dilations and cysts in my liver and pancreas. I am not feeling especially dismal, just frustrated with the lack of information or even theories. I want my doctor to throw me a clue, something to hang onto or look into so I have a better understanding of what has happened and is continuing to happen to my body.
I still greet each day with gratitude, continue to help others in my community, but the fear of the unknown has gotten a hold of me like tentacles and I cannot escape. I understand patience is a virtue, and I am my own worst enemy when it comes to being patient. I have been waiting patiently for nearly three years now, and know no more about my condition than when I was first told about it. Am I overreacting in some fashion? It is my nature to want answers, as we all want answers about our bodies. Not getting answers can be frustrating as well. We all know this feeling.
Maybe I will get my paints out tonight and paint a piece with a liver, something abstract. I have been baking all day, and this too has been therapeutic. I feel like I am channeling Martha Stewart with all this bread I have been baking. It really is quite good and easy. Bob's Redmill Artisian flour. No Knead Rustic Round. I have probably made 15 loaves in the past 2 months. For those who love bread but have never made it, it is an easy recipe and the bread is delicious.

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Hello @frances007,

Your frustration is so understandable! I was on a path for about 20 years looking for a label to put on a neurological problem. I finally found it, but in the intervening years before the diagnosis I felt much like you. I had certainly given up on a "cure" but I was so content to finally have a name to put on the symptoms. I have a feeling that a label/diagnosis is what you are also looking for.

Keep on the journey. I'm glad that you have found baking bread to be a therapeutic endeavor. Being faithful to the process of finding a diagnosis does require patience and persistence. Do you have any other questions prior to your March appointment with the liver specialist?

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@frances007

I recently met with a rheumatologist who did not think that my bile duct dilation was caused by any autoimmune disease. Today I received a message that some tests showed negative findings of any autoimmune liver disease process. As you can imagine, this path I have been on has had so many twists that I feel like I need a new compass. I have lost 1/4 of my weight, have chronic diarrhea and nausea, as well as upper abdomen pain. I understand that the hepatologist I will see this March may be able to shed more light on my condition. I am an information junkie and the most frustrating part of all of this is that none of my current doctors are able to tell me what is going on or what has caused the bile duct dilations and cysts in my liver and pancreas. I am not feeling especially dismal, just frustrated with the lack of information or even theories. I want my doctor to throw me a clue, something to hang onto or look into so I have a better understanding of what has happened and is continuing to happen to my body.
I still greet each day with gratitude, continue to help others in my community, but the fear of the unknown has gotten a hold of me like tentacles and I cannot escape. I understand patience is a virtue, and I am my own worst enemy when it comes to being patient. I have been waiting patiently for nearly three years now, and know no more about my condition than when I was first told about it. Am I overreacting in some fashion? It is my nature to want answers, as we all want answers about our bodies. Not getting answers can be frustrating as well. We all know this feeling.
Maybe I will get my paints out tonight and paint a piece with a liver, something abstract. I have been baking all day, and this too has been therapeutic. I feel like I am channeling Martha Stewart with all this bread I have been baking. It really is quite good and easy. Bob's Redmill Artisian flour. No Knead Rustic Round. I have probably made 15 loaves in the past 2 months. For those who love bread but have never made it, it is an easy recipe and the bread is delicious.

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I have been advised to consider Whipple surgery for currently benign IPMN. I am in very good health but main duct dilated 7mm. I have no underlying conditions but have been told so many things that I, too, am no closer to making a decision and I have been this way for 9 years, only had been told about this dilation 8 months ago..

REPLY
@hopeful33250

Hello @frances007,

Your frustration is so understandable! I was on a path for about 20 years looking for a label to put on a neurological problem. I finally found it, but in the intervening years before the diagnosis I felt much like you. I had certainly given up on a "cure" but I was so content to finally have a name to put on the symptoms. I have a feeling that a label/diagnosis is what you are also looking for.

Keep on the journey. I'm glad that you have found baking bread to be a therapeutic endeavor. Being faithful to the process of finding a diagnosis does require patience and persistence. Do you have any other questions prior to your March appointment with the liver specialist?

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Thank you.
I have started a list of questions, but have not finalized them. I will await the return of my former rheumatologist from her vacation and seek her input. Your note and others make me feel less alone with my frustration in trying to get information from doctors. Not all doctors I seem are mystified by health issues. In other words, I guess whatever I have is something my PCP, gastroenterologist and the new rheumatologist do not understand or know how to best treat. I have little confidence in my PCP and have filed a grievance against the gastroenterologist because of the manner in which he has treated me in the past, and also for misinforming me about many things, including but not limited to my current bile duct issue. I had no idea what I was going to be up against when my doctor told me almost 3 years ago that the "wait and see" approach would lead to losing 25 percent of my weight and cause me to experience the symptoms which I currently have. I am not used to advocating for myself, but have had to learn to do so. I think it is a generational thing, at least for me. That saying, "the doctor knows best" has become an oxymoron, and I am finding that many I know are facing similar issues with their health issues. I understand doctors have more work to do these days, probably don't get reimbursed enough from Medicare and things of that nature. However, I still believe that "do no harm" should be front and center even if it means these people who chose to be physicians have to work a little harder, use a computer etc. I mean no disrespect, these are my observations based on my experience. Having said this, it is exhausting and I cheer you for staying on that 20 year path in an effort to get what you needed in an effort to find out what was going on with your body. And yes, I do want to know if there is a name for my condition. I came home tonight from a friend's place, removed my socks and was shocked at how swollen they were. I had asked my PCP about this a few weeks ago, and he had no answer for me as to the cause. Maybe the time is drawing near me to find a new PCP, but I will wait until I see the hepatologist in March before making a decision. I guess my therapist was on to something when she told me that when my PCP asked me a few weeks ago if I wanted a different doctor, that that was "doctor talk" for "I don't know what is wrong with you."
Without my art, my bread baking, and many other activities I engage in, I probably would have gone crazy by now.

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Keep looking for doctors who will help you. My sympathy to you in your struggle to find answers. It seems to me that it is more difficult to find excellent PCP than specialists.

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@skiball

Hi Mike,
Thank you for your reply. It sounds as tho you are monitoring and not considering a "preventative" Whipple as has been suggested for me. Had anyone offered you that option over monitoring? My CA19-9 had a value of less <2U/mL
Is that configuration of how your value reads?
I have been told that this IPMN in the head of the pancreas shows a 7mm dilation of the main duct? What if any is your duct dilated to?
Thanks in advance~ Bev

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Dear Skiball, thanks for replying. Actually my CA-19 was provided as a number (16). Anything under 32 was considered normal.

Regarding Whipple surgery they claim at the present time it would be more risky to do the surgery on a benign cyst specifically because it is located in the back portion of the pancreas near a few veins. Ducts have not (yet) been involved. Since there was no additional growth, they suggested that I get my next MRI in six months rather than three. Then we’ll take it from there. My best to you, as well as thoughts and prayers. Remember to trust in God‘s will.

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I’m a Newbie. I too have have battled … 40 years for me. Those of you who have a diagnosis of pancreatic cysts … Do you have any other type cysts/fatty tumors on your body or perhaps in your mouth ? My gastro wants to throw a pill at everything that occurs. I have demanded a CT abdomen with contrast. I am allergic to iodine .. never an anaphylactic reaction .. I told my daughter I’d rather die from the contrast than continue to live in the pain I’ve experienced since Aug 2022. A colonoscopy triggered my latest symptoms.
I have been fired by 4 doctors in the last 8 years because I was advocating for myself. Y’all continue to be your own best advocate.
So glad I’ve found you

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I had the Whipple surgery in 2021 for SD IPMN. Pathology report confirmed no cancer.
I recently had my second MRI post Whipple surgery. I have a history of heditary pancreatitis since 11 years of age. My MRI result confirmed main duct dilation at 8 mm though the body area. No mention of tumor or cyst. The Radiologist recommended follow up with a CT scan. Can main pancreas duct be dilated without a tumor or cyst present? I also have Lynch Syndrome. Thank you.

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@dar22

I had the Whipple surgery in 2021 for SD IPMN. Pathology report confirmed no cancer.
I recently had my second MRI post Whipple surgery. I have a history of heditary pancreatitis since 11 years of age. My MRI result confirmed main duct dilation at 8 mm though the body area. No mention of tumor or cyst. The Radiologist recommended follow up with a CT scan. Can main pancreas duct be dilated without a tumor or cyst present? I also have Lynch Syndrome. Thank you.

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I was told in June of 2022 that I have a main duct dilation of 8mm. It was also seen in 2013 but I was not told. Suggested protocol is monitoring every 6 months with MRI. My doctor thinks Whipple is inevitable so I got 2 other opinions. One doctor felt not necessarily inevitable. The other said he would recommend it because I am in good health with no underlying conditions, and that I would have a better outcome now at my age (70). At this point I will stay with monitoring. I have had no symptoms and both times it was seen was incidental to something else, kidney stone in 2013 and diverticulitis in 2022. Have you gotten other opinions about your case?

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