Pancreatic Cysts
Pancreatic cysts are fluid-filled sacs that develop within or on the pancreas. While many are benign and asymptomatic, certain types carry a risk of malignancy, necessitating careful evaluation and management.
Types of Pancreatic Cysts
Pancreatic cysts are broadly categorized into non-neoplastic (typically benign) and neoplastic (potentially cancerous) types
- Pancreatic Pseudocyst: Often arising after acute or chronic pancreatitis or trauma, these cysts are fluid collections without an epithelial lining They may resolve spontaneously or require drainage if symptomatic or infected
- Serous Cystadenoma: Common in elderly females, these benign cysts have a microcystic appearance and are usually asymptomatic Surgical removal is considered if they are large (>4 cm), symptomatic, or have an inconclusive diagnosis
- Mucinous Cystic Neoplasm (MCN): Predominantly found in middle-aged women, MCNs have malignant potential Surgical excision is recommended due to the risk of progression to cancer
- Intraductal Papillary Mucinous Neoplasm (IPMN): These cysts arise from the pancreatic ducts and can be of the main duct or branch duct type Main duct IPMNs have a higher risk of malignancy and often warrant surgical intervention
- Solid Pseudopapillary Neoplasm (SPN): A rare tumor affecting young women, SPNs have low malignant potential but are typically treated with surgical resection
- Neuroendocrine Tumors: These can present as cystic lesions and may be functional (hormone-producing) or non-functional Management depends on size, functionality, and malignancy risk
Many pancreatic cysts are asymptomatic and discovered incidentally during imaging for other reason. When symptoms occur, they may includ:
Abdominal pan Nausea or vomitig Unintended weight los Jaundice (yellowing of the skin and eye) Early satiety or a feeling of fullnes
Evaluation of pancreatic cysts involves a combination of imaging and, in some cases, fluid analyss:
Imaging Studies:
- MRI/MRCP: Provides detailed images of the pancreas and ducs.
- CT Scan: Helps assess cyst size, location, and characteristis.
- Endoscopic Ultrasound (EUS): Allows for close imaging and potential fine-needle aspiration (FNA) of cyst flud.
Cyst Fluid Analysis (via EUS-FNA):
- CEA (Carcinoembryonic Antigen): Elevated levels suggest mucinous cyss.
- Amylase: High levels may indicate a pseudocyt.
- Cytology: Examines cells for atypia or malignany.
- Molecular Markers: Detection of mutations (e.g., KRAS, GNAS) can aid in diagnoss.
Management depends on the cyst type, size, symptoms, and malignancy rsk:
- Observation: Small, asymptomatic cysts without concerning features may be monitored with periodic imagng.
- Surgical Resection: Indicated for cysts with high-risk features, symptomatic lesions, or confirmed neoplam. Surgical approaches may be open or minimally invasive, depending on the cse.
- Endoscopic Drainage: For pseudocysts causing symptoms or complications, endoscopic procedures can provide relef.
Pancreatic Cysts (Disease of Pancreas Diseaes)
