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  • • Abdominal pain

    • Imaging findings consistent with cystic pancreatic mass

    • May be incidental finding on CT scan

    • Overall better prognosis than pancreatic adenocarcinoma

    • 4 major types:

    • 1. Mucinous cystic neoplasm (MCN)

      2. Serous cystic neoplasm (SCN)

      3. Intraductal papillary mucinous neoplasm (IPMN)

      4. Solid pseudopapillary tumor (SPT)

    • All have malignant potential except SCN, which is very seldom invasive or metastatic.

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Epidemiology

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  • MCN (1-2% of pancreatic tumors)

    • -2:1 female predominance

      -Most in body or tail of pancreas

      -Usual age at diagnosis fourth or fifth decade

      -High malignant potential to develop mucinous cystadenocarcinoma

    SCN (1-2% of pancreatic tumors)

    • -2:1 female predominance

      -Usual age at diagnosis seventh decade

      -Rarely malignant

    IPMN (< 5% of pancreatic tumors)

    • -Usually older age at diagnosis

      -Most in head of pancreas

      -35% with invasive adenocarcinoma

    SPT (< 1% of pancreatic tumors)

    • -Commonly in women < 25 years old

      -Most in tail of pancreas

      -Metastases in 10-15% of patients at presentation

      -Seldom invasive

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Symptoms and Signs

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  • • Epigastric mass

    • Abdominal pain

    • Jaundice if tumor obstructs biliary tract.

    • IPMN may be associated with acute pancreatitis

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Imaging Findings

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  • CT scan

    • -MCN: Unilocular or multilocular cyst

      -SCN: Honeycomb pattern of microcysts

      -IPMN: Cyst communicates with often dilated pancreatic duct

      -SPT: Sharply circumscribed with thick pericystic fibrous capsule

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  • • Cystic tumor of the pancreas apparent on CT scan

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Rule Out

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  • • Pancreatic pseudocyst if associated with acute or chronic pancreatitis

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  • • CT scan for diagnosis and assessment of resectability

    • ERCP for biliary decompression if associated with symptomatic jaundice

    • Pancreatic biopsy indicated prior to neoadjuvant or palliative therapy if tumor unresectable

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When to Admit

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  • • Severe symptoms or cholangitis associated with biliary obstruction

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Surgery

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  • • Pancreatic resection if resectable

    • Pancreaticoduodenectomy for tumors in pancreatic head

    • Distal pancreatectomy for lesions in pancreatic body or tail

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Indications

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  • • All cystic neoplasms should be resected

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Contraindications

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  • • Unresectable lesions: Vascular encasement or occlusion on CT scan

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Complications

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  • • Malignant degeneration

    • Biliary obstruction

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Prognosis

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  • • MCN: 70% at 5 years

    • SCN: Resection curative

    • IPMN: > 60% at 5 years

    • SPT: 95% cured with resection

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References

Balcom JH et al. Cystic lesions in the pancreas: when to watch, when to resect. Curr Gastroenterol Rep. 2000;2:152.
Sarr MG et al. Cystic neoplasms of the pancreas: benign to malignant epithelial neoplasms. Surg Clin North Am. 2001;81:497.  [PubMed: 11459267]

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