Cystic tumors of the pancreas: Opportunities and risks

Abstract

neoplasms of the pancreas can be considered as the pancreatic analogon to colonic polyps. Treatment of these precursor lesions at an early stage can potentially reduce pancreas cancer mortality and introduce a new "era" of preemptive pancreatic surgery. However, only few of those lesions have an aggressive behavior. The accuracy of preoperative diagnosis, i.e. , the distinction between the various PCNs is around 60%, and the ability to predict the future outcome is also less accurate. For this reason, a significant number of patients are currently over-treated with an unnecessary, high-risk surgery. Furthermore, the majority of patients with PCN are on life-long follow-up with imaging modality, which has huge cost implications for the Health Care System for limited benefits considering that a significant proportion of PCNs are or behave like benign lesions. The current guidelines for the diagnosis and management of PCNs are more based on expert opinion than on evidence. For all those reasons, the management of cystic tumors of the pancreas remains a controversial area of pancreatology. On one hand, the detection of PCNs and the surgical treatment of pre-cancerous neoplasms can be considered a big opportunity to reduce pancreatic cancer related mortality. On the other hand, PCNs are associated with a considerable risk of under-or over-treatment of patients and incur high costs for the Health Care System. Core tip: The present paper is an editorial focused on the critical problems regarding the management strategy of pancreatic cystic neoplasms (PCNs). Being a pre-cancerous condition in most of the cases, PCNs represent a unique opportunity to prevent pancreatic cancer and to develop preemptive pancreatic surgery programs. However, the lack of predictive factors of the behaviour of these lesions, the low accuracy of AbstractPancreatic cystic neoplasms (PCNs) are a high prevalence disease. It is estimated that about 20% of the general population is affected by PCNs. Some of those lesions can progress till cancer, while others behave in a benign fashion. In particular intraductal papillary mucinous 29May 15, 2015|Volume 6|Issue 2|

A Case Of Cystic Pheochromocytoma With Hypertension And Headaches Mimicking A Large Pancreatic Cystic Tumor

“…As cystic pheochromocytomas become larger, they are more difficult to discriminate between pancreatic lesions and adrenal tumors (2,5). Although both CT and MRI are suitable for morphologic discrimination, they are not useful for diagnosing pheochromocytoma because of poor specificity (70%) (12).…”

“…In all these cases, the patients were normotensive and had no specific symptoms before the surgical removal of the pheochromocytoma, and all of them experienced a sudden rise in systolic blood pressure during the operation. The accuracy of pre-operative differential diagnosis for pancreatic mucinous cystic neoplasia remains poor (63%), and erroneous diagnosis occurs in 8.5% of the cases (2,11); therefore, the diagnosis of pheochromocytoma should be prioritized to prevent potentially lethal sudden hypertension during the operation.…”

“…Cystic tumors of the pancreas, which are classified into neoplastic and nonneoplastic cysts, are often detected by conventional imaging modalities during routine medical checkups. Such lesions are accompanied by the accumulation of necrotic tissues, blood components, pancreatic fluids, and mucin (2,3). A large, cystic pheochromocytoma without any specific symptoms along with elevated catecholamine levels may be diagnosed occasionally (4,5); these large, cystic lesions may be confused with pancreatic tumors, liver abscesses, and liver cysts due to their similar imaging findings (6)(7)(8).…”

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

“…There is, however, a school of thought that in absence of risk factors for malignancy and/or worrisome features on radiological assessment, mucin producing cystic lesions of the pancreas (IPMN and MCN) can be conservatively managed as long as the diameter does not exceed 4 cm provided that the patient is followed up promptly [28]. Understandably, vigilance has to be exercised if the latter policy is followed.…”

Diseases of the Pancreas

“…Due to the slightly increased risk of malignancy in incidental cysts, mainly in the younger than 65 of years, incidentally found pancreatic cysts have to be assessed carefully without exaggerating unnecessary therapeutical consequences [13,14].…”