Cystic neoplasms of the pancreas: A diagnostic challenge

Abstract

Cystic neoplasms of the pancreas are increasingly recognized due to the expanding use and improved sensitivity of cross-sectional abdominal imaging. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite significant improvements in imaging technology and the advent of endoscopic-ultrasound (EUS)-guided fineneedle aspiration, the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge. The first diagnostic step is to differentiate between pancreatic pseudocyst and cystic neoplasm. If a pseudocyst has been effectively excluded, the cornerstone issue is then to determine the malignant potential of the pancreatic cystic neoplasm. In the majority of cases, the correct diagnosis and successful management is based not on a single test but on incorporating data from various sources including patient history, radiologic studies, endoscopic evaluation, and cyst fluid analysis. This review will focus on describing the various types of cystic neoplasms of the pancreas, their malignant potential, and will provide the clinician with a comprehensive diagnostic approach.

Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle

“…Peripheral wall curvilinear calcifications (egg shell calcification) are characteristic of these lesions, although present in less than 10%-25% of cases [49] , and are considered predictive of malignancy [47] . BD-IPMNs (and sometimes MIX-IPMNs) need a differential diagnosis with the other pancreatic cystic lesions.…”

“…CEA is considered the most accurate marker in differentiating mucinous from non-mucinous cysts. There is continual debate in the literature over the best cut-off of CEA levels for discriminating mucinous from non-mucinous cysts The value of cut-off ranges from 20 ng/mL to 800 ng/mL in different studies, obviously with greater sensitivity for a low cut-off value and greater specificity for higher ones [27,49] . However, the most frequently utilized cut-off derives from a large prospective study by Brugge et al [61] on 112 patients who underwent surgery.…”

Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

“…Mucinous cystic neoplasms (MCN): Represent 40% -50% of primary cystic tumours of the pancreas [7]. These tumours are formed of mucin producing cells and are characterised by the presence of ovarian like stoma [10] which stains for human chorionic gonadotropin in 62% of cases [11] although non ovarian stoma MCNs have been reported [7].…”

“…These tumours are formed of mucin producing cells and are characterised by the presence of ovarian like stoma [10] which stains for human chorionic gonadotropin in 62% of cases [11] although non ovarian stoma MCNs have been reported [7]. They always occur in females in their middle age i.e.…”

Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

“…However, current diagnostic methods (crosssectional imaging, EUS, and fluid analysis including cytology, fluid characteristics, chemistry, and tumor markers) do not allow an accurate differentiation between the various types of cysts [148,149] . A novel needle-based confocal laser endomicroscopy (nCLE) miniprobe that can be passed through a 19-G EUS-FNA needle enables realtime imaging with microscopic detail.…”