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 MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. 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 Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth