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Evaluation and Management of the Patient with a Pancreatic Cyst

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Hepato-Pancreato-Biliary Malignancies

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Abstract

Pancreas cysts are frequently incidentally detected on cross-sectional imaging. This review presents an approach to the diagnosis and management of pancreas cysts, including pancreas pseudocysts, serous cystadenomas and mucinous cysts, which include mucinous cystadenomas and intraductal papillary neoplasms

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References

  1. Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol. 2015;6(4):375–88.

    PubMed  PubMed Central  Google Scholar 

  2. Yoon WJ, Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin N Am. 2012;41:103–18.

    Article  Google Scholar 

  3. Basar O, Brugge WR. My treatment approach: pancreatic cysts. Mayo Clin Proc. 2017;92(10):1519–31.

    Article  PubMed  Google Scholar 

  4. Kimura W, Nagai H, Kuroda A, Muto T, Esaki Y. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. 1995;18(3):197–206.

    Article  CAS  PubMed  Google Scholar 

  5. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191(3):802–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol. 2010;105(9):2079–84.

    Article  PubMed  Google Scholar 

  7. Matsubara S, Tada M, Akahane M, et al. Incidental pancreatic cysts found by magnetic resonance imaging and their relationship with pancreatic cancer. Pancreas. 2012;41(8):1241–6.

    Article  PubMed  Google Scholar 

  8. Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113(4):464–79.

    Article  PubMed  Google Scholar 

  9. Scheiman JM, Hwang JH, Moayyedi P. American Gastroenterological Association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):824–48.

    Article  PubMed  Google Scholar 

  10. Gardner TB, Glass LM, Smith KD, et al. Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol. 2013;108:1546–50.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Choi SH, Park SH, Kim KW, et al. Progression of unresected intraductal papillary mucinous neoplasms of the pancreas to cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017;15:1509–20.

    Article  PubMed  Google Scholar 

  12. Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part II: diagnosis, complications, and management. Dis Mon. 2015;61(1):5–37.

    Article  PubMed  Google Scholar 

  13. Aghdassi A, Mayerle J, Kraft M, et al. Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas. 2008;36:105–12.

    Article  PubMed  Google Scholar 

  14. Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta classification for acute pancreatitis: a pictorial essay. Radiographics. 2016;36(3):675–87.

    Article  PubMed  Google Scholar 

  15. Muniraj T, Jamidar PA, Nealon WH, Aslanian HR. Endoscopic management of pancreatic fluid collections. J Clin Gastroenterol. 2017;51(1):19–33.

    Article  PubMed  Google Scholar 

  16. Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol. 2009;15:38–47.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cannon JW, Callery MP, Vollmer CM Jr. Diagnosis and management of pancreatic pseudocysts: what is the evidence? J Am Coll Surg. 2009;209:385–93.

    Article  PubMed  Google Scholar 

  18. Ortiz V, Yousaf MN, Muniraj T, Jamidar P, Aslanian HR. Endoscopic management of pancreatic duct disruption with large mediastinal pseudocyst. VideoGIE. 2018;3(5):162–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Garcea G, Ong SL, Rajesh A, et al. Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology. 2008;8:236–51.

    Article  CAS  PubMed  Google Scholar 

  20. Brugge WR. The use of EUS to diagnose cystic neoplasms of the pancreas. Gastrointest Endosc. 2009;69:S203–9.

    Article  PubMed  Google Scholar 

  21. Van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. 2005;62:383–9.

    Article  PubMed  Google Scholar 

  22. Pitman MB, Lewandrowski K, Shen J, et al. Pancreatic cysts: preoperative diagnosis and clinical management. Cancer Cytopathol. 2010;118:1–13.

    Article  PubMed  Google Scholar 

  23. Turner BG, Brugge WR. Pancreatic cystic lesions: when to watch, when to operate, and when to ignore. Curr Gastroenterol Rep. 2010;12:98–105.

    Article  PubMed  Google Scholar 

  24. Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68:1102–11.

    Article  PubMed  Google Scholar 

  25. Panamonta N, Ngamruengphong S, Kijsirichareanchai K, et al. Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol. 2012;24:1355–62.

    Article  PubMed  Google Scholar 

  26. Park DH, Lee SS, Moon SH, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41:842–8.

    Article  CAS  PubMed  Google Scholar 

  27. Samuelson AL, Shah RJ. Endoscopic management of pancreatic pseudocysts. Gastroenterol Clin N Am. 2012;41:47–62.

    Article  Google Scholar 

  28. Brugge WR. Endoscopic approach to the diagnosis and treatment of pancreatic disease. Curr Opin Gastroenterol. 2013;29:559–65.

    Article  PubMed  Google Scholar 

  29. Kosmahl M, Egawa N, Schröder S, et al. Mucinous nonneoplastic cyst of the pancreas: a novel nonneoplastic cystic change? Mod Pathol. 2002;15:154.

    Article  PubMed  Google Scholar 

  30. Ramsden KL, Newman J. Lymphoepithelial cyst of the pancreas. Histopathology. 1991;18:267.

    Article  CAS  PubMed  Google Scholar 

  31. Nasr J, Sanders M, Fasanella K, et al. Lymphoepithelial cysts of the pancreas: an EUS case series. Gastrointest Endosc. 2008;68:170.

    Article  PubMed  Google Scholar 

  32. Farrell JJ, Fernández-del CC. Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology. 2013;144(6):1303–15.

    Article  PubMed  Google Scholar 

  33. Farrell JJ, Brugge WR. Intraductal papillary mucinous tumor of the pancreas. Gastrointest Endosc. 2002;55(6):701–14.

    Article  PubMed  Google Scholar 

  34. Sahani DV, Lin DJ, Venkatesan AM, et al. Multidisciplinary approach to diagnosis and management of intraductal papillary mucinous neoplasms of the pancreas. Clin Gastroenterol Hepatol. 2009;7:259–69.

    Article  PubMed  Google Scholar 

  35. Farrell JJ. Intraductal papillary mucinous neoplasm to pancreas ductal adenocarcinoma sequence and pancreas cancer screening. Endosc Ultrasound. 2018;7(5):314–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Muniraj T, Aslania HR. Awash in a multitude of pancreas cysts: can we stop looking? Clin Gastroenterol Hepatol. 2016;14(6):872–4.

    Article  PubMed  Google Scholar 

  37. Stark A, Donahue TR, Reber HA, et al. Pancreatic cyst disease: a review. JAMA. 2016;315:1882–93.

    Article  CAS  PubMed  Google Scholar 

  38. Sahora K, Ferrone CR, Brugge WR, et al. Effects of comorbidities on outcomes of patients with intraductal papillary mucinous neoplasms. Clin Gastroenterol Hepatol. 2015;13:1816–23.

    Article  PubMed  Google Scholar 

  39. Tirkes T, Aisen AM, Cramer HM, et al. Cystic neoplasms of the pancreas; findings on magnetic resonance imaging with pathological, surgical, and clinical correlation. Abdom Imaging. 2014;39:1088–101.

    Article  PubMed  Google Scholar 

  40. Jones MJ, Buchanan AS, Neal CP, et al. Imaging of indeterminate pancreatic cystic lesions: a systematic review. Pancreatology. 2013;13:436–42.

    Article  CAS  PubMed  Google Scholar 

  41. De Jong K, Van Hooft JE, Nio CY, et al. Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions. Scand J Gastroenterol. 2012;47:1056–63.

    Article  PubMed  Google Scholar 

  42. Khashab MA, Kim K, Lennon AM, et al. Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms. Pancreas. 2013;42:717–21.

    Article  PubMed  Google Scholar 

  43. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.

    Article  PubMed  Google Scholar 

  44. Tirkes T, Aisen AM, Cramer HM, et al. Cystic neoplasms of the pancreas; findings on magnetic resonance imaging with pathological, surgical, and clinical correlation. Abdom Imaging. 2014;39:1088–101.

    Article  PubMed  Google Scholar 

  45. Kamata K, Kitano M, Omoto S, et al. Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts. Endoscopy. 2016;48:35–41.

    PubMed  Google Scholar 

  46. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126(5):1330–6.

    Article  PubMed  Google Scholar 

  47. Maker AV, Carrara S, Jamieson NB, et al. Cyst fluid biomarkers for intra-ductal papillary mucinous neoplasms of the pancreas: a critical review from the international expert meeting on pancreatic branch-duct-intra-ductal papillary mucinous neoplasms. J Am Coll Surg. 2015;220:243–53.

    Article  PubMed  Google Scholar 

  48. Farrell JJ, Al-Haddad MA, Jackson SA, Gonda TA. Incremental value of DNA analysis in pancreatic cysts stratified by clinical risk factors. Gastrointest Endosc. 2019;89(4):832–841.e2.

    Article  PubMed  Google Scholar 

  49. Majumbar S, Aslanian HR, Farrell JJ, et al. Novel methylated DNA markers discriminate advanced neoplasia in pancreatic cysts: marker discovery, tissue validation, and cyst fluid testing. Am J Gastroenterol. 2019;114(9):1539–49.

    Article  Google Scholar 

  50. Dal Molin M, Matthaei H, Wu J, et al. Clinicopathological correlates of activating GNAS mutations in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Surg Oncol. 2013;20:3802–8.

    Article  Google Scholar 

  51. Kawakubo K, Tada M, Isayama H, et al. Risk for mortality from causes other than pancreatic cancer in patients with intraductal papillary mucinous neoplasm of the pancreas. Pancreas. 2013;42:687–91.

    Article  PubMed  Google Scholar 

  52. Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–51.

    Article  CAS  PubMed  Google Scholar 

  53. Lévy P, Jouannaud V, O’Toole D, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol. 2006;4:460–8.

    Article  PubMed  Google Scholar 

  54. Kim TH, Song TJ, Hwang JH, et al. Predictors of malignancy in pure branch duct type intraductal papillary mucinous neoplasm of the pancreas: a nationwide multicenter study. Pancreatology. 2015;15:405–10.

    Article  PubMed  Google Scholar 

  55. Pai M, Senturk H, Lakhtakia S, et al. 351 endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) for cystic neoplasms and neuroendocrine tumors of the pancreas. Gastrointest Endosc. 2013;77:AB143–4.

    Article  Google Scholar 

  56. Gomez V, Takahashi N, Levy MJ, et al. EUS-guided ethanol lavage does not reliably ablate pancreatic cystic neoplasms (with video). Gastrointest Endosc. 2016;83:914–20.

    Article  PubMed  Google Scholar 

  57. Oyama H, Tada M, Takagi K, et al. Long-term risk of malignancy in branch-duct intraductal papillary mucinous neoplasms. Gastroenterology. 2020;158:226–37.

    Article  CAS  PubMed  Google Scholar 

  58. Muniraj T, Aslanian HR. Long-term follow-up of low-risk branch duct IPMNs of the pancreas: watch for main pancreatic duct dilatation, and for how long? Clin Transl Gastroenterol. 2018;9:198.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Kwong WT, Hunt GC, Fehmi SM, et al. Low rates of malignancy and mortality in asymptomatic patients with suspected neoplastic pancreatic cysts beyond 5 years of surveillance. Clin Gastroenterol Hepatol. 2016;14:865–71.

    Article  PubMed  Google Scholar 

  60. Berland LL, Silverman SG, Megibow AJ, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7:754–73.

    Article  PubMed  Google Scholar 

  61. Chandwani R, Allen PJ. Cystic neoplasms of the pancreas. Annu Rev Med. 2016;67:45–57.

    Article  CAS  PubMed  Google Scholar 

  62. Jimenez RE, Warshaw AL, Z’Graggen K, et al. Sequential accumulation of K-ras mutations and p53 overexpression in the progression of pancreatic mucinous cystic neoplasms to malignancy. Ann Surg. 1999;230:501–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Iacobuzio-Donahue CA, Wilentz RE, Argani P, et al. Dpc4 protein in mucinous cystic neoplasms of the pancreas: frequent loss of expression in invasive carcinomas suggests a role in genetic progression. Am J Surg Pathol. 2000;24:1544–8.

    Article  CAS  PubMed  Google Scholar 

  64. Park JW, Jang JY, Kang MJ, et al. Mucinous cystic neoplasm of the pancreas: is surgical resection recommended for all surgically fit patients? Pancreatology. 2014;14:131–6.

    Article  PubMed  Google Scholar 

  65. Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg. 2006;30:2236–45.

    Article  PubMed  Google Scholar 

  66. Procacci C, Carbognin G, Accordini S, et al. CT features of malignant mucinous cystic tumors of the pancreas. Eur Radiol. 2001;11:1626–30.

    Article  CAS  PubMed  Google Scholar 

  67. CrippaS SR, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;247:571–9.

    Article  Google Scholar 

  68. Procacci C, Graziani R, Bicego E, et al. Serous cystadenoma of the pancreas: report of 30 cases with emphasis on the imaging findings. J Comput Assist Tomogr. 1997;21:373–82.

    Article  CAS  PubMed  Google Scholar 

  69. Belsley NA, Pitman MB, Lauwers GY, et al. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2008;114:102–10.

    Article  PubMed  Google Scholar 

  70. Papavramidis T, Papavramidis S. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J Am Coll Surg. 2005;200:965–72.

    Article  PubMed  Google Scholar 

  71. Butte JM, Brennan MF, Gönen M, et al. Solid pseudopapillary tumors of the pancreas: clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J Gastrointest Surg. 2011;15(2):350–7.

    Article  PubMed  Google Scholar 

  72. Bhatnagar R, Olson MT, Fishman EK, Hruban RH, Lennon AM, Ali SZ. Solid-pseudopapillary neoplasm of the pancreas: cytomorphologic findings and literature review. Acta Cytol. 2014;58(4):347–55.

    Article  PubMed  Google Scholar 

  73. Reddy S, Cameron JL, Scudiere J, et al. Surgical management of solid-pseudopapillary neoplasms of the pancreas (Franz or Hamoudi tumors): a large single-institutional series. J Am Coll Surg. 2009;208(5):950–7; discussion 957–959

    Article  PubMed  PubMed Central  Google Scholar 

  74. Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudo-papillary neoplasms: are these rare lesions? Pancreas. 2014;43:331–7.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Hoi JY, Kim MJ, Kim JH, et al. Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. AJR Am J Roentgenol. 2006;187:W178–86.

    Article  Google Scholar 

  76. Jani N, Dewitt J, Eloubeidi M, et al. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy. 2008;40:200–3.

    Article  CAS  PubMed  Google Scholar 

  77. Li-Geng T, Cai G, Aslanian HR. EUS diagnosis of cystic pancreatic neuroendocrine tumors. VIDEOGIE. 2018;3(3):106–108.

    Google Scholar 

  78. Muniraj T, Vignesh S, Shetty S, Thiruvengadam S, Aslanian HR. Pancreatic neuroendocrine tumors. Dis Mon. 2013;59:5–19.

    Article  PubMed  Google Scholar 

  79. Kunz PL, Reidy-Lagunes D, Anthony LB, North American Neuroendocrine Tumor Society, et al. Consensus guidelines for the management and treatment of neuroendocrine tumours. Pancreas. 2013;42(4):557–77.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Boninsegna L, Partelli S, D’Innocenzio MM, et al. Pancreatic cystic endocrine tumors: a different morphological entity associated with a less aggressive behavior. Neuroendocrinology. 2010;92(4):246–51.

    Article  CAS  PubMed  Google Scholar 

  81. Gaujoux S, Tang L, Klimstra D, et al. The outcome of resected cystic pancreatic endocrine neoplasms: a case-matched analysis. Surgery. 2012;151(4):518–25.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Brooklyn Hospital Center, Brooklyn, NY, USA

    Suut Göktürk

  2. Section of Digestive Diseases, Yale University, New Haven, CT, USA

    Thiruvengadam Muniraj & Harry R. Aslanian

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  1. Suut Göktürk
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  2. Thiruvengadam Muniraj
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  3. Harry R. Aslanian
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Correspondence to Harry R. Aslanian .

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Editors and Affiliations

  1. Medical Director, Capital Health Medical Center Hopewell, Pennington, NJ, USA

    Cataldo Doria

  2. Capital Health Center for Digestive Health, Pennington, NJ, USA

    Jason N. Rogart

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Göktürk, S., Muniraj, T., Aslanian, H.R. (2021). Evaluation and Management of the Patient with a Pancreatic Cyst. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-37482-2_27-1

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  • DOI: https://doi.org/10.1007/978-3-030-37482-2_27-1

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