Cystic pancreatic lesions: Current evidence for diagnosis and treatment

Abstract

Pancreatic cystic neoplasms are detected at an increasing frequency due to an increased use and quality of abdominal imaging. There are well known differential diagnostic difficulties concerning these lesions. The aim is to review current literature on the diagnostic options and the following treatment for cystic lesions in the pancreas focusing on serous cystadenomas, primary mucinous neoplasm of the pancreas and mucinous cystadenocarcinomas, as well as intraductal papillary mucinous neoplasms, starting with excluding pseudocysts. A conservative approach is feasible in patients with a clinical presentation suggestive of an asymptomatic serous cystadenoma. Surgical management, as well as follow-up, is discussed for each of the types of neoplastic lesions, including an uncharacterized cyst, based on patient data, symptoms, serum analysis, cyst fluid analysis and morphological features. Aspects for future diagnostics and management of these neoplasia are commented upon.

Pancreatic ductal adenocarcinoma and acinar cells: a matter of differentiation and development?

“…Therefore PanIN-2 lesions can be regarded as a turning point in this sequence of progression and as a major target for further study. Other mucinous precursor lesions, such as intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms, are subjects of increasing attention because of their raising incidence and they provide greater opportunities for improved clinical management 6 7…”

Diagnostic utility of clinical and biochemical parameters in pancreatic head malignancy patients with normal carbohydrate antigen 19-9 levels

“…Although abdominal pain was nonspecific 18 , it was the most frequent onset symptom in pancreatic cancer 15,19 , and it was proven to have certain relation with tumor location in pancreatic adenocarcinoma 20 . On the other hand, patients with benign lesions did not often appear with abdominal pain until it reached considerable size and gave rise to the obstruction of the pancreatico-biliary duct 21 . Therefore, abdominal pain probably correlated with malignancy more closely, and this kind of potential tendency might be amplified on the condition that patients' CA19-9 levels were under 37u/ml.…”

The incidental cystic pancreas mass: a practical approach

“…Although accurate characterization of unilocular cysts is challenging, CT findings, including the location in the pancreatic head, lobulated contour, absence of wall enhancement, and lack of mural nodule, in an elderly woman are specific for the diagnosis of SC. The presence of peripheral tumoral calcification has a significant association with MCN [ 14 , 15 , 33 ] .…”