Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 ++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] Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.