Pancreatic cystic neoplasms: predictors of malignant behavior and management

Abstract

Background/aim: Pancreatic cystic neoplasms are being increasingly identified with the widespread use of advanced imaging techniques. In the absence of a good radiologic or pathologic test to preoperatively determine the dianosis, clinical characteristics might be helpful. The objectives of this analysis were to define the incidence and predictors of malignancy in pancreatic cysts.

Patients and methods: Patients with true pancreatic cysts who were treated at our institution were included. Patients with documented pseudocysts were excluded. Demographic data, clinical manifestations, radiological, surgical, and pathological records of those patients were reviewed.

Results: Eighty-one patients had true pancreatic cyst. The mean age was 47 ± 15.5 years. There were 28.4% serous cystadenoma, 21% mucinous cystadenoma, 6.2% intraductal papillary tumors, 8.6% solid pseudopapillary tumors, 1.2% neuroendocrinal tumor, 3.7% ductal adenocarcinoma, and 30.9% mucinous cystadenocarcinoma. Malignancy was significantly associated with men (P = 0.04), older age (0.0001), cysts larger than 3 cm in diameter (P = 0.001), presence of solid component (P = 0.0001), and cyst wall thickening (P = 0.0001). The majority of patients with malignancy were symptomatic (26/28, 92.9%). The symptoms that correlated with malignancy included abdominal pain (P = 0.04) and weight loss (P = 0.0001). Surgical procedures were based on the location and extension of the lesion.

Conclusion: The most common pancreatic cysts were serous and mucinous cysts. These tumors were more common in females. Old age, male gender, large tumor, presence of solid component, wall thickness, and presence of symptoms may predict malignancy in the cyst.

Figure 1

MRCP for pancreatic cystic lesion in the head of pancreas in a female patient aged 15 years; histopathology revealed solid pseudopapillary tumor

Figure 2

Pancreatic cystic lesion in the head of pancreas in a female patient aged 24 years; histopathology revealed mucinous cystadenoma

Figure 3

Pancreatic cystic lesion in the body of pancreas in a female patient aged 35 years; histopathology revealed serous cystadenoma (mid-pancreatectomy)

Figure 4

Pancreatic cystic lesion in the tail of pancreas in a male patient aged 52 years with solid areas inside; histopathology revealed mucinous cystadenocarcinoma

Figure 5

Mid-pancreatectomy for serous cystadenoma in mid body of pancreas in a female patient aged 49 years