Pancreatic pseudocyst or a cystic tumor of the pancreas?

Abstract

Pancreatic pseudocysts are the most common cystic lesions of the pancreas and may complicate acute pancreatitis, chronic pancreatitis, or pancreatic trauma. While the majority of acute pseudocysts resolve spontaneously, few may require drainage. On the other hand, pancreatic cystic tumors, which usually require extirpation, may disguise as pseudocysts. Hence, the distinction between the two entities is crucial for a successful outcome. We conducted this study to highlight the fundamental differences between pancreatic pseudocysts and cystic tumors so that relevant management plans can be devised. We reviewed the data of patients with pancreatic cystic lesions that underwent intervention between June 2007 and December 2010 in our hospital. We identified 9 patients (5 males and 4 females) with a median age of 40 years (range, 30–70 years). Five patients had pseudocysts, 2 had cystic tumors, and 2 had diseases of undetermined pathology. Pancreatic pseudocysts were treated by pseudocystogastrostomy in 2 cases and percutaneous drainage in 3 cases. One case recurred after percutaneous drainage and required pseudocystogastrostomy. The true pancreatic cysts were serous cystadenoma, which was treated by distal pancreatectomy, and mucinous cystadenocarcinoma, which was initially treated by drainage, like a pseudocyst, and then by distal pancreatectomy when its true nature was revealed. We conclude that every effort should be exerted to distinguish between pancreatic pseudocysts and cystic tumors of the pancreas to avoid the serious misjudgement of draining rather than extirpating a pancreatic cystic tumor. Additionally, percutaneous drainage of a pancreatic pseudocyst is a useful adjunct that may substitute for surgical drainage.

Prevalence and outcomes of cystic lesions of the transplant pancreas: The University of Wisconsin Experience

“…In the native pancreas, pancreatic pseudocysts are the most common form of cysts, comprising 75% of all cystic lesions of the pancreas, of which 15% are neoplastic,; hence a misdiagnosis of a neoplastic cyst as a pseudocyst can occur . This compares to our cohort where the majority of TPCL were benign pseudocysts (16/22; 73%) and 27% (6/22) were neoplastic, benign, or malignant.…”

Pancreatic pseudocyst or mucinous cystadenocarcinoma of pancreas? A diagnostic dilemma

“…With a history of acute pancreatitis, surgeons often tend to diagnose newly discovered pancreatic cyst as a pseudocyst. Nevertheless, the possibility of a cystic neoplasm should always be taken into account . In this case, prior history of abdominal pain suggested a diagnosis of pancreatic pseudocyst in the beginning, but, later, evidences pointed toward mucinous cystic neoplasm.…”

Diabetes Mellitus and Pancreatic Cysts in African Americans

“…1 Pseudocysts are the most common cystic lesions and may be formed in the setting of acute pancreatitis, chronic pancreatitis, or pancreatic trauma. 2 Age, C-reactive protein, and high lactate dehydrogenase seem to be risk factors and indicators for pancreatic fluid collections and pseudocyst formation. One of the most common pancreatic-associated disorders is diabetes mellitus (DM).…”