Cystic Tumors of the Pancreas

Abstract

By virtue of rapid advancements in imaging techniques such as CT or MRI and their increased access and use, cystic tumors of the pancreas are being recognized with increasing frequency and have become a common finding in clinical practice. Furthermore, the decreasing risk of pancreatic surgery has led to an increase in the number of resected cystic tumors of the pancreas, which in turn has conspicuously widened our knowledge of these specific disease entities. Cystic pancreatic tumors and tumorlike lesions represent a wide spectrum of histopathology from purely benign to overly malignant (Table 19.1). This is in contrast to hepatic and renal cysts which are mostly dismissed because of their universally benign nature. The first and most important diagnostic strategy for accurate characterization of cystic pancreatic tumors is to differentiate non-mucinous cystic tumor such as serous cystic neoplasm (SCN) from mucinous types of tumors, including mucinous cystic neoplasm (MCN) or intraductal papillary mucinous neoplasm (IPMN). The reason is that SCN should be managed as a benign disease while mucinous lesions are potentially or overtly malignant lesions, surgery being generally the treatment of choice. Besides those purely cystic tumors, solid pancreatic tumors such as solid pseudopapillary neoplasm (SPN), ductal adenocarcinoma, or neuroendocrine tumor (NET) may often display cystic features, leading to the difficulty in the differentiation.