Cystic pancreatic lesions: Can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment?

Introduction

Cystic lesions of the pancreas consist of a spectrum of benign, pre-malignant, and malignant malignancies. In the past, cystic neoplasms of the pancreas were thought to be relatively rare, but the widespread use of cross sectional imaging has dramatically increased ability to detect these lesions. Although the vast majority of pancreatic cysts are discovered incidentally, large or invasive lesions may produce sufficient symptoms to cause the patient to seek medical attention.

Cystic neoplasms are often confused or misdiagnosed as pseudocysts or peripancreatic collections of inflammatory fluid that may morphologically mimic cystic neoplasms. Furthermore, the presenting symptoms of pseudocysts may be identical to the symptoms associated with cystic neoplasms.

Cystic neoplasms of the pancreas are traditionally organized by the type of lining epithelium since this feature dominates the risk of malignancy and management [1] (Table [1]). There are three types of mucinous lesions, benign mucinous cystadenomas, malignant mucinous cystic lesions, and intra-ductal papillary mucinous neoplasms (IPMNs). The non-mucinous lesions include serous cystadenomas, cystic endocrine tumors and other rare lesions.

Table 1 Tumor Type Gender Age Morphology Type of Epithelium Risk of Malignancy Mucinous Cystadenoma Female Middle-Aged Unilocular Mucinous Moderate Mucinous Cystic Neoplasm Female Middle-Aged Associated mass Malignant Mucinous High Intra-ductal Papillary Mucinous Tumor Mixed Elderly Unilocular, septated, associated dilated ducts Papillary Mucinous Moderate Serous Cystadenoma Female Middle-Aged Microcystic Serous (PAS positive for glycogen) Low Cystic Endocrine Tumor Mixed Middle-Aged Associated mass Endocrine Low Solid Cystic Pseudopapillary Tumor Female Young Mixed solid and cystic Endocrine-like Low

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