Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are rare entities that can present complex diagnostic and therapeutic dilemmas for the clinician. Diagnosis is often made incidentally on cross-sectional imaging, as the clinical symptoms arising from IPMN are often vague and nonspecific. The progression of IPMN to pancreatic ductal adenocarcinoma has been clearly documented; however, many IPMN harbor low malignant potential and do not require resection. Specific clinical, imaging, and biochemical features have been described which can help evaluate a particular IPMN’s risk profile and are classified as either “high-risk stigmata” or “worrisome features.” Measurement of cyst carcinoembryonic antigen (CEA) levels allows differentiation of mucinous from non-mucinous cysts, however not benign from malignant cysts. Cytologic evaluation of cyst fluid can be helpful in diagnosing an occult malignancy within an IPMN; however, its sensitivity is low, and its use should be restricted to centers with expertise in this technique. The duration and intensity of surveillance are based upon the patient’s suitability for surgery, family history of pancreas cancer, and individual cyst features.
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