Asymptomatic Cysts Research Articles

Requirement of a single high-risk feature as an indication for EUS for the diagnosis of asymptomatic pancreatic cysts

Background and aimsEndoscopic ultrasound (EUS) is widely used to evaluate pancreatic cysts. Recent American Gastroenterological Association (AGA) guideline limits EUS for evaluation of cysts with at-least two high-risk features (size ≥ 3 cm, dilated main pancreatic duct or presence of a solid component). We have investigated the impact of this guideline on sensitivity of EUS for pancreatic cancer and the reduction of EUS procedures for pancreas cysts. MethodsEUS procedures performed between 2004 and 2015 and related patient records were retrospectively reviewed to determine the presence or absence of high-risk features, and for the results of fine needle aspiration cytology. ResultsTwo hundred ten patients (108 males) underwent EUS for diagnostic evaluation of pancreatic cysts. Four patients (1.9%), all with at-least one high-risk feature, were diagnosed with cytologically-proven pancreatic cancer. Only 2 patients with cancer had at-least two high-risk features that would have warranted EUS examination based on the new AGA guideline. The requirement for at-least two high-risk features would have decreased the number of EUS procedures by 91%, but reduced the sensitivity for pancreatic malignancy to 50%. If only one high-risk feature was required, EUS procedures would have been decreased by 67%, with a sensitivity of 100%. ConclusionLimiting EUS to patients with pancreatic cysts with 2 or more high-risk features may substantially reduce the sensitivity for pancreatic malignancy. Performing EUS in patients with at least one high-risk feature may substantially decrease the need of invasive procedures without reducing sensitivity for detecting malignancy.

Validation of the 2015 AGA Guideline for asymptomatic neoplastic pancreatic cysts focused on completion of follow up after 5-year surveillance

Validation of the 2015 AGA Guideline for asymptomatic neoplastic pancreatic cysts focused on completion of follow up after 5-year surveillance

Surveillance of Asymptomatic Pancreatic Cysts – How Long is Long Enough?

Surveillance of Asymptomatic Pancreatic Cysts – How Long is Long Enough?

217 Application of 2015 American Gastroenterological Association Guidelines on a Retrospective Cohort of Patients With Asymptomatic Pancreatic Cysts: Can We Truly Forego Endoscopic Ultrasound?

Objective: Asymptomatic pancreatic cysts are frequently diagnosed on cross-sectional imaging. Recently, the American Gastroenterological Association (AGA) has put forth guidelines regarding management of these cysts. To date, there is no strong data to indicate whether these guidelines will accurately identify malignancy and mitigate unnecessary endoscopic ultrasound (EUS) procedures. The aim of this investigation was to apply the 2015 AGA guidelines to a retrospective cohort of asymptomatic pancreatic cysts in a large regional referral center. Materials and Methods: This is a retrospective cohort study of patients with asymptomatic pancreatic cysts who underwent EUS with fine-needle aspiration (FNA) over a 3-year period. We applied current AGA guidelines to determine how many EUS procedures would be avoided, and further assessed whether the guidelines adequately identified cases of malignancy. Results: Forty-five patients were identified who underwent EUS FNA for an asymptomatic pancreatic cyst from 2011 to 2014. The mean age was 65 years, and the mean size cyst size was 2.8 cm. According to the 2015 AGA guidelines, EUS was indicated in 13 of the 45 patients and surveillance imaging in the remaining 32 patients. 3 of these 32 patients had atypical cytology on EUS FNA, and final histology showed adenocarcinoma in 2 patients and IMPN with high-grade dysplasia in 1 patient. Conclusion: Applying AGA guidelines in this study cohort would have prevented 32 out of 45 (71%) EUS procedures; however, 3 of these 32 patients had early occult malignancy. This data suggest that additional strategies are needed to identify those patients at high risk.

Su1330 Endoscopic and Fluid analysis Risk Factors for High grade dysplasia and malignancy in Pancreatic Cysts

The recent American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts, recommend EUS-FNA for pancreatic cysts that are > 3cm, have an associated solid component and/or pancreatic duct dilation. Patients with high-grade dysplasia (HGD) or malignancy on cytology are referred for surgery. Data supporting these recommendations come from surgical series and as such represent a subset of patients undergoing evaluation. Furthermore, strong evidence supporting pancreatic dilation as a risk factor is lacking.

More than ten millions Europeans have an asymptomatic pancreatic cyst. A San Marino nationwide population-based study on pancreatic cyst prevalence

More than ten millions Europeans have an asymptomatic pancreatic cyst. A San Marino nationwide population-based study on pancreatic cyst prevalence

Su1378 Performance of Guidelines for Asymptomatic Pancreatic Cysts

Su1378 Performance of Guidelines for Asymptomatic Pancreatic Cysts

Natural history of colloid cysts of the third ventricle.

OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-prediction model was defined using bootstrapped logistic regression. Predictive factors were then combined into a simple 5-point clinical scale referred to as the Colloid Cyst Risk Score (CCRS), and this was evaluated with receiver-operator characteristics. RESULTS The study included 163 colloid cysts, more than half of which were discovered incidentally. More than half of the incidental cysts (58%) were followed with surveillance neuroimaging (mean follow-up 5.1 years). Five patients with incidental cysts (8.8%) progressed and underwent resection. No patient with an incidental, asymptomatic colloid cyst experienced acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly half (46.2%) of symptomatic patients presented with hydrocephalus. Eight patients (12.3%) presented acutely, and there were 2 deaths due to obstructive hydrocephalus and herniation. The authors identified several factors that were strongly correlated with the 2 outcome variables and defined third ventricle risk zones where colloid cysts can cause obstructive hydrocephalus. No patient with a lesion outside these risk zones presented with obstructive hydrocephalus. The CCRS had significant predictive capacity for symptomatic clinical status (area under the curve [AUC] 0.917) and obstructive hydrocephalus (AUC 0.845). A CCRS ≥ 4 was significantly associated with obstructive hydrocephalus (p < 0.0001, RR 19.4). CONCLUSIONS Patients with incidentally discovered colloid cysts can experience both lesion enlargement and symptom progression or less commonly, contraction and symptom regression. Incidental lesions rarely cause acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly one-half of patients with symptomatic colloid cysts present with obstructive hydrocephalus, which has an associated 3.1% risk of death. The CCRS is a simple 5-point clinical tool that can be used to identify symptomatic lesions and stratify the risk of obstructive hydrocephalus. External validation of the CCRS will be necessary before objective surgical indications can be established. Surgical intervention should be considered for all patients with CCRS ≥ 4, as they represent the high-risk subgroup.

A Multidisciplinary Approach to Improving Appropriate Follow-Up Imaging of Ovarian Cysts: A Quality Improvement Initiative

PurposeIncidental ovarian cysts are frequently detected on imaging. Despite published follow-up consensus statements, there remains variability in radiologist follow-up recommendations and clinician practice patterns. The aim of this study was to evaluate if collaborative ovarian cyst management recommendations and a radiologist decision support tool can improve adherence to follow-up recommendations. MethodsGynecologic oncologists and abdominal radiologists convened to develop collaborative institutional recommendations for the management of incidental, asymptomatic simple ovarian cysts detected on ultrasound, CT, and MRI. The recommendations were developed by modifying the published consensus recommendations developed by the Society of Radiologists in Ultrasound on the basis of local practice patterns and the experience of the group members. A less formal process involved the circulation of the published consensus recommendations, followed by suggestions for revisions and subsequent consensus, in similar fashion to the ACR Incidental Findings Committee II. The recommendations were developed by building on the published work of experienced groups to provide the authors’ medical community with a set of recommendations that could be endorsed by both the Department of Gynecology and the Department of Radiology to provide supportive guidance to the clinicians who manage incidental ovarian cysts. The recommendations were integrated into a radiologist decision support tool accessible from the dictation software. Nine months after tool launch, institutional review board approval was obtained, and radiology reports mentioning ovarian cysts in the prior 34 months were retrospectively reviewed. For cysts detected on ultrasound, adherence rates to Society of Radiologists in Ultrasound recommendations were calculated for examinations before tool launch and compared with adherence rates to the collaborative institutional recommendations after tool launch. Additionally, electronic medical records were reviewed to determine the follow-up chosen by the clinician. ResultsFor cysts detected on ultrasound, radiologist adherence to recommendations improved from 50% (98 of 197) to 80% (111 of 139) (P < .05). Overmanagement decreased from 34% (67 of 197) to 10% (14 of 139) (P < .05). A recommendation was considered “overmanaged” if the radiologist recommended follow-up when it was not indicated or if the recommended follow-up time was at a shorter interval than indicated. Clinician adherence to radiologist recommendations showed statistically nonsignificant improvement from 49% (36 of 73) to 57% (27 of 47) (P = .5034). ConclusionsManagement recommendations developed through collaboration with clinicians may help standardize follow-up of ovarian cysts and reduce overutilization.

Arachnoid cysts of the central nervous system. Algorithms and recommendations for management

The symptoms related to the presence of arachnoid cysts in the Central Nervous System depend on the size of the cyst and its growth rate, its location and, in some cases, the associated CSF dynamic disorder. Sometimes there is acute clinical presentation due to cyst rupture or acute bleeding. Although it is generally accepted that asymptomatic or paucisymptomatic cysts do not require surgical treatment, there is no consensus on the therapeutic approach of choice in symptomatic cases. The aim of this paper is to review the literature, analyzing the pros and cons of the three main surgical options (microsurgery, neuroendoscopy, and CSF shunt) based primarily on the location of the cyst. Although treatment must be always individualized, basic management recommendations may be offered.

Follow-up of asymptomatic pancreatic cysts in clinical practice: A vignette questionnaire

In absence of evidence-based guidelines of pancreatic cystic neoplasms (PCN), the management might vary among physicians. The aim of this survey was to assess the attitude of Dutch gastroenterologists (GE) towards the management of asymptomatic PCNs. An anonymous online questionnaire was distributed to all practicing GE (n=381) in The Netherlands, in which four vignette patients with PCN were presented. In total 45% of GE responded. Most respondents would perform surveillance for a 10mm PCN (78%) mainly with an interval of one year (57%). A shorter interval of three (26%) or six (57%) months was chosen for a 25mm BD-IPMN. Ultrasound was recommended for surveillance by 19% for a 10mm cyst. GE with EUS experience were more likely to apply EUS for surveillance of 10mm cyst than those without (56% vs 28%; p<0.001). The presence of a branch-duct intraductal mucinous neoplasm (BD-IPMN) with a mural nodule, dilated pancreatic duct (8mm) or increased serum CA 19.9 (300U/ml) were considered an indication for resection by respectively 88%, 68% and 51% of respondents. Dutch GE demonstrate substantial variability in the management of asymptomatic PCNs. A significant proportion of general GE still use ultrasound for surveillance of small PCNs, while GE with EUS experience were more likely to perform EUS. The presence of risk factors for malignant degeneration of IPMN were not recognized by a substantial proportion of GE. Data on the natural history of PCNs is required to provide input for evidence-based guidelines, which should lead to a more uniform approach.

Diagnosis of neonatal ovarian torsion: Emphasis on prenatal and postnatal sonographic findings.

Our aim was to retrospectively review the imaging findings of patients with neonatal ovarian torsion, emphasizing prenatal and postnatal sonographic findings. Eleven patients who had had neonatal ovarian torsion diagnosed surgically (n = 9) or clinicoradiologically (n = 2) were enrolled. Prenatal and postnatal sonographic features, including sequential postnatal change, were reviewed. Clinical and pathologic features were also investigated. All patients except one had a fetal ovarian cyst (mean, 5.3 cm) detected on third-trimester sonography, either simple (n = 6) or complex (n = 4). In all 11 patients, initial postnatal sonography had revealed a complex cyst (mean, 4.7 cm) with intracystic clot or debris, the double-wall sign, a fluid-fluid level, and multiple septation. None of the patients had had symptoms or signs related to the ovarian torsion. Follow-up sonography in seven patients had revealed increased echogenicity of the cyst wall with frequent calcification and a decrease in size of the cyst. In two patients, the interval of the change in cyst position was noted, and autoamputation of the torsed ovary had been surgically confirmed. Serous cystadenoma had been identified in one patient. Neonatal ovarian torsion most commonly manifests as an asymptomatic complex cyst on sonography due to torsion of a fetal ovarian cyst. Serial monitoring of a fetal ovarian cyst for its resolution or changes in its appearance is mandatory for making an early diagnosis of torsion. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:290-297, 2016.

A thoracic duct cyst in 10-year-old boy: The youngest case report and review of the literature

We report the youngest case with a thoracic duct cyst located just above the diaphragm that was treated with thoracoscopic resection. The cyst was observed with serial ultrasonographic examinations during his prenatal period. No interval evidence of a deleterious effect to the fetus by this cyst was observed and born by normal vaginal delivery at term. Although the boy remained clinically asymptomatic at the age of ten, surgical excision for definitive diagnosis of the cyst was undertaken. The mediastinal cyst contained milky-white chylous fluid. Pathologically, the wall was similar in structure to the thoracic duct. The mediastinal thoracic duct cyst is an extremely rare cystic lesion. The etiology may be related to a congenital or degenerative weakness in the wall of the thoracic duct. They are generally asymptomatic but may sometimes cause pressure effects on adjacent structures. Surgical resection is the treatment of choice. The thoracoscopic resection is especially advisable for the patient with a small, asymptomatic cyst. Chylothorax is the most common postoperative complication. To avoid chylothorax after the resection of a mediastinal thoracic duct cyst, identification of the communication of the cyst with thoracic duct and ligation of its inferior pedicle without fail is necessary.

Entamoeba thiol-based redox metabolism: A potential target for drug development

Amebiasis is an intestinal infection widespread throughout the world caused by the human pathogen Entamoeba histolytica. Metronidazole has been a drug of choice against amebiasis for decades despite its low efficacy against asymptomatic cyst carriers and emergence of resistance in other protozoa with similar anaerobic metabolism. Therefore, identification and characterization of specific targets is urgently needed to design new therapeutics for improved treatment against amebiasis. Toward this goal, thiol-dependent redox metabolism is of particular interest. The thiol-dependent redox metabolism in E. histolytica consists of proteins including peroxiredoxin, rubrerythrin, Fe-superoxide dismutase, flavodiiron proteins, NADPH: flavin oxidoreductase, and amino acids including l-cysteine, S-methyl-l-cysteine, and thioprolines (thiazolidine-4-carboxylic acids). E. histolytica completely lacks glutathione and its metabolism, and l-cysteine is the major intracellular low molecular mass thiol. Moreover, this parasite possesses a functional thioredoxin system consisting of thioredoxin and thioredoxin reductase, which is a ubiquitous oxidoreductase system with antioxidant and redox regulatory roles. In this review, we summarize and highlight the thiol-based redox metabolism and its control mechanisms in E. histolytica, in particular, the features of the system unique to E. histolytica, and its potential use for drug development against amebiasis.

An Epidurogram During Fluoroscopy-Guided Caudal Epidural Reveals an Asymptomatic Tarlov Cyst in a Patient with Lumbar Radicular Pain: A Case Report

Objective: Tarlov cysts are cerebrospinal fluid dilatations of the nerve root sheath at the dorsal root ganglion level. We report the incidental finding of a Tarlov cyst during a fluoroscopy-guided caudal epidural injection in a patient with acute lumbar radicular pain due to disc herniation. Case report: A 76-year-old male was scheduled for an epidural steroid injection (ESI) for acute L5 radicular pain caused by a paracentral disc nucleous pulposus herniation. The ESI was administered via a caudal route because the patient had back surgery at the L3-L4 for Mal de Pott tuberculoses when he was 23-years old. The epidurogram revealed a fusiform image at the sacral level and the procedure was stopped. Afterwards, an MRI showed a sacral cyst of 50 × 18 mm and a left paracentral disc herniation at L4-L5 with L5 root compression. Conclusion: The use of fluoroscopy with epidurogram during a caudal ESI allowed us to confirm epidural needle placement and to observe the cephalic flow of contrast medium into the level and side to treat. Without fluoroscopy, we would not have found this asymptomatic Tarlov cyst.

When everything failed, glidescope prevailed.

Sir, We report the successful management of an unanticipated difficult airway secondary to an asymptomatic large vallecular cyst obscuring the glottic opening using glidescope after repeated failed attempts at mask ventilation and laryngoscopy. A 70-year-old, 60 kg, American Society of Anesthesiologists (ASA) I male patient was scheduled to undergo re-exploration for persistent bleeding following transurethral resection of the prostate. The preanesthetic checkup and airway examination was unremarkable. General Anesthesia was planned in view of ongoing blood loss. Patient was shifted to the operating room and connected to the multichannel monitor (Datex-Ohmeda, Finland). Intravenous access (i.v.) was established with 18G cannula, and i.v. glycopyrrolate 0.2 mg and morphine 6 mg was given. Patient was preoxygenated with 100% oxygen for 3 min and then induced with sleep dose of thiopentone. After confirming assisted mask ventilation, i.v vecuronium (0.1 mg/kg) was given but, immediately after full muscle relaxation was achieved, absent capnography trace along with minimal movement of the chest was noticed. Guedel's airway was inserted, mask position and adequate seal reconfirmed and any leaks or equipment failure was ruled out. With failure to ventilate even now, it was decided to perform direct laryngoscopy to facilitate endotracheal intubation. Meanwhile, the anesthesia technician was also requested to bring a glidescope as the fiberoptic bronchoscope was not available. Since the patient was routinely preoxygenated with 100% oxygen, the SpO2 could be maintained at around 93% throughout till successful intubation could be accomplished. A large vallecular cyst was detected arising from the right vallecula obscuring the glottic opening entirely [Figure 1]. After two unsuccessful attempts to visualize the glottis, it was decided to use glidescope which revealed a small aperture glottic opening, distorted and displaced by the cyst. 7.0 mm cuffed oral endotracheal tube was passed beyond the cyst into the trachea and confirmed by capnogram. The cyst was then aspirated to prevent any problems at extubation. Patient was maintained on controlled ventilation using 66% nitrous oxide in oxygen with 1% isoflurane. He also received i.v 8 mg of dexamethasone following intubation. The surgery continued uneventfully for 1 h. At the end of surgery, neuromuscular blockade was reversed with 50 μg/kg of i.v neostigmine and 10 μg/kg of i.v glycopyrrolate. His trachea was extubated uneventfully. He was then shifted to postanesthesia care unit and discharged from the ward 2 days later.Figure 1: Vallecular cyst obstructing the laryngeal inletGlidescope is a new addition to the armamentarium for managing a difficult airway. Although it has been used to achieve primary airway control in anticipated, symptomatic large vallecular cyst,[1] it also helps in unanticipated difficult airway by improving the Cormack-Lehane grading and making part of the airway visible. By virtue of its inherent design of bent tip at 60°, the structures that are obscured on direct laryngoscope may be readily observed with the use of glidescope.[23] It is already established that the use of glidescope has a high success rate in both primary airway control as well as failed direct laryngoscopy.[4] The ASA difficult airway guidelines have also incorporated glidescope for improved laryngeal view and increased successful intubations.[5] This equipment use avoids multiple attempts at successful tracheal intubation. Therefore, it may be used as a tangible alternative device in a situation where tracheal placement seems to be rather difficult or impossible.

American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data

The American Gastroenterological Association (AGA) recently reported evidence-based guidelines for the management of asymptomatic neoplastic pancreatic cysts. These guidelines advocate a higher threshold for surgical resection than prior guidelines and imaging surveillance for a considerable number of patients with pancreatic cysts. The aims of this study were to assess the accuracy of the AGA guidelines in detecting advanced neoplasia and present an alternative approach to pancreatic cysts. The study population consisted of 225 patients who underwent EUS-guided FNA for pancreatic cysts between January 2014 and May 2015. For each patient, clinical findings, EUS features, cytopathology results, carcinoembryonic antigen analysis, and molecular testing of pancreatic cyst fluid were reviewed. Molecular testing included the assessment of hotspot mutations and deletions for KRAS, GNAS, VHL, TP53, PIK3CA, and PTEN. Diagnostic pathology results were available for 41 patients (18%), with 13 (6%) harboring advanced neoplasia. Among these cases, the AGA guidelines identified advanced neoplasia with 62% sensitivity, 79% specificity, 57% positive predictive value, and 82% negative predictive value. Moreover, the AGA guidelines missed 45% of intraductal papillary mucinous neoplasms with adenocarcinoma or high-grade dysplasia. For cases without confirmatory pathology, 27 of 184 patients (15%) with serous cystadenomas (SCAs) based on EUS findings and/or VHL alterations would continue magnetic resonance imaging (MRI) surveillance. In comparison, a novel algorithmic pathway using molecular testing of pancreatic cyst fluid detected advanced neoplasias with 100% sensitivity, 90% specificity, 79% positive predictive value, and 100% negative predictive value. The AGA guidelines were inaccurate in detecting pancreatic cysts with advanced neoplasia. Furthermore, because the AGA guidelines manage all neoplastic cysts similarly, patients with SCAs will continue to undergo unnecessary MRI surveillance. The results of an alternative approach with integrative molecular testing are encouraging but require further validation.

Low Rates of Malignancy and Mortality in Asymptomatic Patients With Suspected Neoplastic Pancreatic Cysts Beyond 5Years of Surveillance.

The 2015 American Gastroenterological Association guidelines recommend discontinuation of surveillance of pancreatic cysts after 5 years, although there are limited data to support this recommendation. We aimed to determine the rate of pancreatic cancer development from neoplastic pancreatic cysts after 5 years of surveillance. We performed a retrospective multicenter study, collecting data from 310 patients with asymptomatic suspected neoplastic pancreatic cysts, identified by endoscopic ultrasound from January 2002 to June 2010 at 4 medical centers in California. All patients were followed up for 5 years or more (median, 87 mo; range, 60-189 mo). Data were used to calculate the risk for pancreatic cancer and all-cause mortality. Three patients (1%) developed invasive pancreatic adenocarcinoma. Based on American Gastroenterological Association high-risk features (cyst size > 3 cm, dilated pancreatic duct, mural nodule), risks for cancer were 0%, 1%, and 15% for patients with 0, 1, or 2 high-risk features, respectively. Mortality from nonpancreatic causes was 8-fold higher than mortality from pancreatic cancer after more than 5 years of surveillance. There is a very low risk of malignant transformation of asymptomatic neoplastic pancreatic cysts after 5 years. Patients with pancreatic lesions and 0 or 1 high-risk feature have a less than 1% risk of developing pancreatic cancer, therefore discontinuation of surveillance can be considered for select patients. Patients with neoplastic pancreatic cysts with 2 high-risk features have a 15% risk of subsequent pancreatic cancer, therefore surgery or continued surveillance should be considered.

Spleen Salvaging Treatment Approaches in Non-parasitic Splenic Cysts in Childhood.

The aim of this study was to evaluate our experience with primary non-parasitic splenic cysts (NPSC) which are relatively rare in children and consist almost exclusively of single case reports or small case series in the literature. The medical records of all patients who presented to our clinic with NPSC between 2005 and 2015 were evaluated retrospectively. There were 22 children whose ages ranged from 2months to 14years (mean 9.2 ± 4.7years). The size of the cysts was in the range of 5 to 200mm (mean 55.4 ± 48.2mm). Ten patients underwent surgery for splenic cysts. Partial splenectomy (n = 2), total cyst excision (either open n = 4 or laparoscopically n = 1), and total splenectomy (n = 3) were performed. The non-operated patients were asymptomatic and followed with ultrasound (US). The follow-up period in non-operated patients ranged from 6months to 5years (mean 2.27 ± 1.29years). Complete regression was observed in four (33%) non-operated patients. The regressed cyst measurements were 10, 16, 30, and 40mm, respectively. Approximately half of the NPSC is diagnosed incidentally. Small (<5cm) asymptomatic cysts should be under regular follow-up with US/physical examination for regression. If surgery is required, we prefer open cyst excision as it gives excellent results and preserves splenic immune function.

Cystic Lesions of the Pancreas: Observe or Operate.

Cystic Lesions of the Pancreas: Observe or Operate.