II. Epidemiology
- Incidental finding on advanced abdominal imaging in >2% of patients
III. Differential Diagnosis
- Pancreatic Cysts with malignant potential
- Mucinous Pancreatic Cysts
- Intraductal papillary mucinous Pancreatic Cysts
- Solid pseudopapillary pancreatic neoplasms
- Pancreatic Cysts without malignant potential
- Serous Pancreatic Cysts
- Malignancy is rare
- Surgical resection is only indicated if symptomatic or continued growth
- Pseudocysts
- Cysts lack an epithelial lining and typically occur after Pancreatitis
- Non-neoplastic Pancreatic Cysts (rare)
- Includes true cysts, retention cysts, lymphoepithelial cysts, mucinous non-neoplastic cysts
- Serous Pancreatic Cysts
IV. Imaging
- Pitfalls
- Distinguishing Pancreatic Cysts with malignant potential on imaging is challenging
- MRI Abdomen
- Best imaging to characterize Pancreatic Cysts
- Suspicious findings
- Pancreatic Cyst >3 cm
- Associated with Pancreatic Cancer in 15% of cases
- Contrast with <5% malignancy rate in Pancreatic Cysts <3 cm
- Mural Nodules
- Lymphadenopathy
- Involvement of bile duct or pancreatic duct
- Pancreatic Cyst >3 cm
V. Management
- Surgery indications
- Pancreatic Cysts >3 cm with suspicious findings (see above)
- Endoscopic Ultrasound with cyst aspiration indications
- Smaller cysts considered for possible resection
- Biochemical marker analysis to risk stratify cyst malignant potential
- Monitoring with serial imaging
- Pancreatic Cysts 1-3 cm not requiring surgical management or aspiration