Pancreatic cysts: etiology, diagnosis and management

Abstract

<jats:title>Abstract</jats:title><jats:p>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.</jats:p>

Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management

“…IPMN is an exocrine neoplasm of the pancreas consisting of epithelial cells growing within the pancreatic ducts [main pancreatic duct (MPD) or its major branches and producing mucin[ 1 ]. There is no ovarian-type stroma in IPMNs in contrast to mucinous cystic neoplasms[ 2 ]. According to the revised international consensus Fukuoka guidelines (2017)[ 8 ], IPMNs are divided into the following three types: MD-IPMN, BD-IPMN, and MT-IPMN diagnosed in radiological/histological investigations.…”

“…Pancreatic cystic neoplasms represent about 10%-13% of pancreatic cysts, 25% of cystic neoplasms and 1% of pancreatic carcinomas[ 1 , 2 ]. Pancreatic intraductal papillary mucinous neoplasms (IPMNs) are one of the two types of mucin-producing pancreatic cystic tumors (PCTs)[ 1 , 2 ]. According to World Health Organization, IPMNs are neoplasms which grow within the pancreatic ducts and produce mucin.…”

“…According to World Health Organization, IPMNs are neoplasms which grow within the pancreatic ducts and produce mucin. They contain epithelial cells that can create papillary projections[ 2 ]. In 1982, Ohhashi et al [ 3 ], for the first time, reported four cases of mucin-producing pancreatic cancer.…”

The Role of EUS in Pancreatic Cysts

“…Prior to the availability of EUS, transmural endoscopic cyst drainage was reliant on a combination of radiologic imaging to ensure a distance of less than 10 mm between gastrointestinal lumen and cyst. Endoscopic drainage may be performed as so-called single-step endoultrasonography (EUS)-guided and two-(multi)-step EUS-guided drainage techniques [14,17]. EUS has the theoretical advantage of reducing the risks of bleeding, perforation, and, potentially, infection.…”

“…), enzymes (amylase, lipase), and DNA analysis. Analysis of cystic fluid aspirate can be used to differentiate mucinous from non-mucinous cysts with a sensitivity, specificity, and accuracy of 12.5-27, 90-100, and 55%, respectively[7,17].…”