Cystic Neoplasms of the Pancreas: Differential Diagnosis and Radiology Correlation

Abstract

Although the probability of pancreatic cystic neoplasms (PCNs) being detected is raising year by year, their differential diagnosis and individualized treatment are still a challenge in clinical work. PCNs are tumors containing cystic components with different biological behaviors, and their clinical manifestations, epidemiology, imaging features, and malignant risks are different. Some are benign [e.g., serous cystic neoplasms (SCNs)], with a barely possible that turning into malignant, while others display a low or higher malignant risk [e.g., solid pseudopapillary neoplasms (SPNs), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms (MCNs)]. PCN management should concentrate on preventing the progression of malignant tumors while preventing complications caused by unnecessary surgical intervention. Clinically, various advanced imaging equipment are usually combined to obtain a more reliable preoperative diagnosis. The challenge for clinicians and radiologists is how to accurately diagnose PCNs before surgery so that corresponding surgical methods and follow-up strategies can be developed or not, as appropriate. The objective of this review is to sum up the clinical features, imaging findings and management of the most common PCNs according to the classic literature and latest guidelines.

Pancreatic Incidentaloma

“…In addition, the prognosis of IPMN-associated cancer is similar to PDAC [ 35 ]. The typical age for the detection of IPMNs is between the fifth and seventh decade of life and there is no difference in their prevalence between men and women [ 36 ]. IPMN diagnostics include the exclusion of the other PCLs, determination of the potential communication between lesion and MPD, and identification of the key risk factor of malignancy with assessment of the resectability.…”

“…They are relatively infrequent PCLs and account for 29% of all PCNs [ 50 ]. In the comparison to IPMNs, MCNs do not have the connection with the pancreatic duct system and they are mostly large cysts with thick septa, peripheral calcification and mural nodules [ 36 ]. Their prevalence in the body/tail of the pancreas is higher than in the pancreatic head [ 51 ].…”

“…On the other hand, SCNs are representatively honeycombed microcystic tumors consisting of uniform, cuboidal, glycogen-rich epithelial cells. Thus far, there are four variants of serous cystadenoma, namely, macrocystic serous cystadenoma, solid serous adenoma, von Hippel–Lindau-related SCN, and mixed serous neuroendocrine neoplasm, in which the serous epithelial components are identical to those of serous cystadenoma [ 36 ]. It is known that CT is the preferable method as the first-line examination for SCNs.…”

“…Due to the vascularized fibrous septa of the SCN, biopsy may be complicated with hemorrhages. In addition, the cystic fluid level of CEA was found to be low (typical <5 ng/mL) [ 36 ].…”

“…Regarding the typical radiological appearance of these lesions, local capsule interruption, cystic degeneration, calcification and hemorrhage, and floating cloud sign belong to the imaging features. In turn, the cytological assessment usually reveals branching papillae with myxoid stroma [ 36 ].…”