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Central European Journal of Medicine

, Volume 9, Issue 1, pp 92–107 | Cite as

Pancreatic cysts: etiology, diagnosis and management

Review Article

Abstract

Pancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.

Keywords

Hyoid bone Pancreas Cyst Pseudocyst Neoplasm Cystadenoma Drainage Resection 

Abbreviations

ANC

acute necrotic collection

APFC

acute peripancreatic fluid collection

AREG

amphiregulin

CEUS

contrast enhanced ultrasonography

CT

computer tomography

ERCP

endoscopic retrograde cholangiopancretography

ESGE

European Society of Gastrointestinal Endoscopy

EUS

endoscopic ultrasonography

EUS

BR endoscopic ultrasonography guided cytology brushing

FNA

ine needle aspiration

IPMN

intraductal papillary mucinous neoplasm

MCA

mucinous cystadenoma

MRCP

magnetic resonance cholangiopancretography

MRI

magnetic resonance imaging

NOTES

Natural Orifice Translumenal Endoscopic Surgery

SCA

serous cystadenoma

SPN

solid pseudopapillary neoplasm

SPT

solid pseudopapillary tumor

TUS

transabdominal ultrasonography

WON

walled-off necrosis

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© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Digestive Tract SurgeryMedical University of SilesiaKatowicePoland

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