Cystic Tumors of the Pancreas

Abstract

The discovery of a cystic lesion in the pancreas implies a challenge for the physician. Approximately 10% are cystic tumors, benign to highly malignant, or true cysts, showing all stages of cellular differentiation, from benign to highly malignant tumors. Malignant cystic tumors are rare and comprise only about 1% of all pancreatic malignancies, they are potentially curable. Therefore, correct diagnosis and treatment of these lesions are of great importance. It is usually not possible to separate a pseudocyst from a benign cyst or a cystic tumor, but there are some signs and findings that could be helpful in the clinical decision. The diagnosis of a cystic pancreatic tumor requires different imaging techniques, including ultrasonography, computerized tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, but to distinguish a pseudocyst or a benign cyst from a potentially malignant lesion can be very difficult. The usefulness of blood tests and investigations of cyst fluid can be questionable. Today, surgical treatment of cystic pancreatic tumors can be performed with low morbidity. Therefore, we conclude that an active strategy with resection of cystic tumors of the pancreas should be recommended.

Outcomes of Cystic Lesions in the Pancreas After Extended Follow-up

“…Because of the potential risks of premaligancy or malignancy associated with pancreatic cysts, surgical resection has been advocated by some authors [3,5,6]. The justification for an aggressive approach is based on the inability to differentiate benign and malignant cysts, insufficient data on natural history, relatively high incidence of premalignant or malignant cysts, and low morbidity and mortality rate after pancreatic surgery [3,[5][6][7][8][9][10]. However, data collected after surgical resection do not reflect the characteristics of cystic neoplasms incidentally found in the clinical setting.…”

Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings

“…However, recent studies have shown that PDAC may be accompanied by cystic changes within or adjacent to the mass, and that the incidence of PDAC with cystic changes ranges from ,1% to 8% [3,4]. Radiologists should be familiar with PDACs with cystic changes as they may resemble more common cystic pancreatic lesions, such as pseudocysts, intraductal papillary mucinous neoplasms (IPMNs), solid pseudopapillary tumours and non-functioning islet cell tumours, all of which are managed differently and usually have better patient survival rates [5][6][7].Many studies have discussed the radiological appearance of PDAC accompanied by cystic lesions [6][7][8][9][10][11].Most of these studies have discussed pseudocysts or retention cysts depicted adjacent to the PDAC or in the extrapancreatic area in the clinical setting of pancreatitis [8][9][10][11], whereas only a few studies have discussed intratumoral cystic lesions, such as cystic necroses, in larger ordinary PDACs [6,7]. Some case reports have described the intratumoral cystic changes of PDAC variants, i.e.…”

“…However, recent studies have shown that PDAC may be accompanied by cystic changes within or adjacent to the mass, and that the incidence of PDAC with cystic changes ranges from ,1% to 8% [3,4]. Radiologists should be familiar with PDACs with cystic changes as they may resemble more common cystic pancreatic lesions, such as pseudocysts, intraductal papillary mucinous neoplasms (IPMNs), solid pseudopapillary tumours and non-functioning islet cell tumours, all of which are managed differently and usually have better patient survival rates [5][6][7].…”

The Natural History of the Incidentally Discovered Small Simple Pancreatic Cyst: Long-Term Follow-Up and Clinical Implications

“…Therefore, most incidental pancreatic cystic lesions are assumed to be cystic neoplasms. Because of the as-yet-undefined but nevertheless present risk of malignancy, the aggressive approach of surgical resection of these pancreatic cysts has been advocated by some authors [2,4,5]. This recommendation is in contradistinction to the prevailing practice at our institution for small cystic lesions of 2 cm or smaller.…”