Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Aug;6(4):375-88.
doi: 10.3978/j.issn.2078-6891.2015.057.

Diagnosis and management of cystic lesions of the pancreas

William R Brugge  1
Affiliations
Review

Diagnosis and management of cystic lesions of the pancreas

William R Brugge. J Gastrointest Oncol. 2015 Aug.

Abstract

Pancreatic cystic lesions (PCLs) are being increasingly identified in recent years. They show a wide spectrum of imaging and clinical features. The diagnosis and discrimination of these lesions are very important because of the risk for concurrent or later development of malignancy. PCLs are usually first diagnosed and characterized by conventional imaging modalities such as trans-abdominal ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). However, their ability to differentiate the benign and malignant lesions remains limited. Endoscopic US may be more helpful for the diagnosis and differentiation of PCLs because of its high resolution and better imaging characteristics than cross-sectional imaging modalities. It also allows for fine-needle aspiration (FNA) of cystic lesions for biochemical, cytological and DNA analysis that might be further helpful for diagnosis and differentiation. The management options of PCLs are to observe, endoscopic treatment or surgical resection. However, the decision for management is sometimes hampered by limitations in current diagnostic and tissue sampling techniques. As further diagnostic and non-invasive management options become available, clinical decision-making will become much easier for these lesions.

Keywords: Pancreas; cystic lesions; endoscopic ultrasonography (endoscopic US); intraductal papillary mucinous neoplasms (IPMNs); mucinous cyst; pseudocyst.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A schematization of morphologic details in common cysts of pancreas. MCN, mucinous cystic neoplasm; IPMN, intraductal papillary mucinous neoplasm.
Figure 2
Figure 2
EUS-FNA of a pseudocyst with alcoholic chronic pancreatitis. Cyst fluid amylase was very high and cyst cytology was negative for malignant cells, and no definitive epithelial cells were identified. FNA, fine-needle aspiration.
Figure 3
Figure 3
A unilocular, 7 cm in diameter pancreatic pseudocyst with debris.
Figure 4
Figure 4
Endoscopic cystgastrostomy.
Figure 5
Figure 5
MRI finding of a branch-duct IPMN (BD-IPMN) at the tail of the pancreas. Note the fine septations. MRI, magnetic resonance imaging; IPMN, intraductal papillary mucinous neoplasm; BD-IPMN, branch-duct IPMN.
Figure 6
Figure 6
EUS finding of a branch-duct IPMN (BD-IPMN) with a mural nodule (arrow). IPMN, intraductal papillary mucinous neoplasm; BD-IPMN, branch-duct IPMN.
Figure 7
Figure 7
nCLE probe and papillary structures in an intraductal papillary mucinous neoplasms (IPMN) case.
Figure 8
Figure 8
CT findings of SCN. (A) Axial image. Note the septa coming from the central scar; (B) sagittal image. Note the focal high-intensity lesion within a cyst representing hemorrhage (arrow). CT, computed tomography; SCN, serous cystic neoplasm.
Figure 9
Figure 9
Demonstration of vascular network on cyst wall by confocal laser endomicroscopy (CLE) in a patient with serous cystadenoma.
Figure 10
Figure 10
Suggested algorithm for pancreatic cyst management.
See this image and copyright information in PMC

References

    1. Yoon WJ, Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin North Am 2012;41:103-18. - PubMed
    1. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008;191:802-7. - PMC - PubMed
    1. Moparty B, Brugge WR. Approach to pancreatic cystic lesions. Curr Gastroenterol Rep 2007;9:130-5. - PubMed
    1. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004;239:651-7; discussion 657-9. - PMC - PubMed
    1. Kimura W, Nagai H, Kuroda A, et al. Analysis of small cystic lesions of the pancreas. Int J Pancreatol 1995;18:197-206. - PubMed