www.turner-white.com Gastroenterology Volume 14, Part 5 1
Patrick Laing, MD, and Douglas G. Adler, MD, FACG, AGAF, FASGE
Prior to the widespread use of cross-sectional
body imaging, pancreatic cystic lesions were rare
findings, mostly described in case reports. In the
modern era, these lesions are extremely common
due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI)
scans for a variety of indications. The prevalence
of unsuspected pancreatic cysts is 2.6% in asymptomatic adults, and more than 8% in adults
older than 80 years.1–3 Incidental pancreatic cystic lesions can pose a diagnostic dilemma to the
ordering physician because some cysts have no
malignant potential, some are precancerous, and
some can be frankly malignant.
Historically, pancreatic pseudocysts represent-
ed 70% to 80% of all pancreatic cystic lesions,
but currently this figure is reported to be as low as
19%. 4 Pseudocysts are typically associated with
acute and chronic pancreatitis. Pancreatic cystic
neoplasms are cysts that can have malignant po-
tential, as first described by Compagno and Oertel
in 1978.5 They are divided into serous cystadeno-
mas (SCA), mucinous cystadenomas (MCN), and
intraductal pancreatic cystic neoplasms (IPMN).
Differentiating mucinous from nonmucinous cysts
is important because mucinous cysts have greater
malignant potential and may require definitive
management by resection.
Other rare types of cysts, such as congenital
cysts, lymphoepithelial cysts, solid pseudopapillary cysts, neuroendocrine tumors, and cystic variants of pancreatic adenocarcinoma, have been
described. This manual reviews the diagnosis and
management of pancreatic cystic lesions.
Several imaging modalities are used to diagnose
pancreatic cystic lesions. CT is the imaging test of
first choice because it provides detailed information
about the cyst architecture and ductal involvement.
Differentiating mucinous from nonmucinous cystic
lesions is important because of the difference in
malignant potential. Unfortunately, this distinction
can be difficult to make using CT alone, especially
between SCA and MCN. One study reported that
the CT diagnosis of MCN was uncertain in 57% of
patients. 6 MRI and endoscopic ultrasound (EUS)
are helpful in this circumstance. MRI provides
detailed images of septations and walls within
the cysts, and diffusion-weighted MRI can assist
in differentiating mucinous from nonmucinous le-
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