How to differentiate congenital pancreatic cysts and cystic pancreatic teratomas?

Abstract

The differential diagnosis of congenital pancreatic cysts and mature cystic pancreatic teratomas is challenging due to the lack of reliable diagnostic tests or pathognomonic imaging findings. This study highlights the differences between these extremely rare entities with few published case reports. Based on our recent experience with two cases, we conducted an extensive review of literature including all reported cases of congenital pancreatic cysts and cystic pancreatic teratomas in children. We report two cases of large cystic abdominal mass detected by prenatal ultrasonography. Both neonates were asymptomatic after birth and were operated on by laparoscopy at the age of 1 year and 3 months, respectively. Histopathology demonstrated a congenital pancreatic cyst in the first case and a mature cystic teratoma in the second case. The post-operative course was uneventful for both children. We describe the clinical and imaging data of the 33 congenital pancreatic cysts and 10 mature cystic teratomas of the pancreas previously reported in the literature, and discuss diagnosis criteria and treatment strategies. Congenital pancreatic cysts and pancreatic teratomas are rare lesions in children. Clinical presentation is not specific and these lesions are often asymptomatic. Although associated malformations are evocative of congenital pancreatic cyst, the final diagnosis can only be confirmed by histopathological examination. Available treatments include ultrasound-guided puncture, enucleation, distal pancreatectomy, cystogastrostomy, and cysto-jejunostomy by the Roux-en-Y technique. Laparoscopic excision can be performed shortly after birth and is our preferred option.