Pancreatic Cyst Etiology and Evaluation
Pancreatic cysts are being detected with increasing frequency with a prevalence now estimated to be up to 13% of the population when MR imaging is used. On routine imaging studies done for abdominal pain or other complaints referable to the abdomen, it is not uncommon for a clinician to confront the incidental finding of a pancreatic cyst. Because pancreatic cysts can range from benign inflammatory lesions to frankly malignant cystic masses, it is essential for clinicians to have a working knowledge of these lesions.
Etiology of pancreatic cysts
Pancreatic cysts can be classified as either of non-epithelial or epithelial origin, and within each of those categories as non-neoplastic or neoplastic.
: Perhaps most familiar are the non-epithelial non-neoplastic cysts, which include both pseudocysts and parasitic cysts. Non-epithelial neoplastic cysts include lymphangiomas (benign) and sarcomas with cystic degeneration (malignant).
: The most familiar non-neoplastic cysts of epithelial origin include lymphoepithelial cysts, periampullary duodenal wall cysts, retention cysts and congenital cysts. The vast majority of pancreatic cysts fall into the category of neoplastic epithelial cysts. This group can be subdivided into those that are benign, pre-malignant and malignant:
Description of important pancreatic cyst types
How to evaluate pancreatic cystic lesions
In order to determine the necessary workup for a pancreatic cyst, the patient must first be thoroughly evaluated clinically. Essential clinical features that should be considered in the evaluation of patients with pancreatic cysts include the following: current symptoms thought to be referable to the pancreas, a prior history of pancreatitis, a family or personal history of pancreas or other related cancers or syndromes (e.g. multiple endocrine neoplasia). Medical comorbidities which place patients at a prohibitively high operative risk should be carefully evaluated in order to determine if pancreatic resection would be prudent. Older abdominal imaging is very helpful to obtain as well if available as it helps to establish the chronicity and growth rate of any cysts noted.
After a clinical evaluation, the radiographic features can be incorporated and help the clinician to arrive at the most likely etiology for the cystic lesion. Based on that determination, recommendations for additional evaluation or surgical resection can be made.
For more information
The Liver and Pancreas Program at UW Health offers a multidisciplinary approach to patient evaluation and treatment, and its surgeons perform a higher volume of complex liver and pancreas operations than any other center in Wisconsin. To refer a patient or request a consult, contact the Hepatobiliary Pancreas Clinic at (608) 263-7502.
Chandwani R. Cystic Neoplasms of the Pancreas. Annu. Rev. Med. 2016. 67(20):1-20.