Pancreatic Neoplasms, Cystic

• • 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.

Epidemiology

• • 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

Symptoms and Signs

• • Epigastric mass

  • Abdominal pain

  • Jaundice if tumor obstructs biliary tract.

  • IPMN may be associated with acute pancreatitis

Imaging Findings

• • 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

• • Cystic tumor of the pancreas apparent on CT scan

Rule Out

• • Pancreatic pseudocyst if associated with acute or chronic pancreatitis

• • 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

When to Admit

• • Severe symptoms or cholangitis associated with biliary obstruction

Surgery

• • Pancreatic resection if resectable

  • Pancreaticoduodenectomy for tumors in pancreatic head

  • Distal pancreatectomy for lesions in pancreatic body or tail

Indications

• • All cystic neoplasms should be resected

Contraindications

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

Complications

• • Malignant degeneration

  • Biliary obstruction

Prognosis

• • MCN: 70% at 5 years

  • SCN: Resection curative

  • IPMN: > 60% at 5 years

  • SPT: 95% cured with resection

References