Epidemiology, diagnosis, and management of cystic lesions of the pancreas

Abstract

Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated cross-sectional abdominal imaging. Cystic lesions of the pancreas comprise of a heterogeneous group of diagnostic entities, some of which are benign such as inflammatory pseudocysts or serous cystadenomas and do not require resection when asymptomatic. Others like mucinous cysts or intraductal papillary mucinous neoplasms (IPMN) have a malignant potential and in these cases surgical resection is often indicated. For this reason an adequate distinction between the various cysts is crucial to optimize management strategy. Different diagnostic methods that could be of value in the differentiation include radiologic imaging techniques such as CT, MR, and endosonography. In addition, fluid aspiration for cytopathology, tumormarkers or molecular analysis is widely used. Different guidelines are available but so far no optimal diagnostic algorithm exists. We summarize the epidemiology, classification, clinical presentation, diagnostics, management, and future perspectives.

Figure 1

Prevalence of pancreatic cysts in relation to increasing age.

Figure 2

Cystic lesion in the pancreatic head is punctured using a linear array echo-endoscope.

Figure 3

(a) EUS image of a malignant IPMN in the head of the pancreas. (b) MRI image of a malignant IPMN in the head of the pancreas.

Figure 4

(a) EUS image of a serous cystadenoma in the head of the pancreas. (b) MRI image of a serous cystadenoma in the head of the pancreas.