Cystic tumours of the pancreas –⁠ an up-to-date review

Czech version

Authors: F. Čečka ¹; B. Jon ¹; R. Repák ²; Z. Šubrt ^1,3; A. Ferko ¹
Authors‘ workplace: Chirurgická klinika LF UK v Hradci Králové a FN Hradec Králové, Přednosta: prof. MUDr. Alexander Ferko, CSc. ¹; II. interní klinika LF UK v Hradci Králové a FN Hradec Králové, Přednosta: prof. MUDr. Jaroslav Malý, CSc. ²; Univerzita obrany, Brno, Fakulta vojenského zdravotnictví, Hradec Králové, Katedra válečné chirurgie, Vedoucí katedry: doc. MUDr. Leo Klein, CSc. ³
Published in: Prakt. Lék. 2011; 91(7): 388-391
Category: Reviews

Overview

Cystic tumours of the pancreas are lesions with a dominant cystic portion. Its incidence has been increasing in recent years, which may be due to the increasing frequency of imaging examinations. The main clinical problem is its differenatial diagnosis, which may be difficult. In the differential diagnosis of cystic lesions of the pancreas, it is important to distinguish between

–⁠ inflammatory lesions,

–⁠ inborn cystic lesions, and

–⁠ solid malignant tumours with cystic degeneration.

The most frequent cystic tumours of the pancreas are

♦ intraductal papillary mucinous neoplasia (IPMN),

♦ serous cystadenoma (SCA), and

♦ mucinous cystic neoplasia (MCN).

In this paper, the authors describe the typical characteristics of cystic tumours, and particularly focus on diagnostic methods, of which endoscopic ultrasonography is of great importance.

Key words:
cystic tumours of pancreas, endoscopic ultrasonography, pancreatic resection.

Sources

1. Garcea, G., Ong, S.L., Rajesh, A., et al. Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology 2008, 8(3), p. 236-251.

2. Lewandrowski, K.B., Southern, J.F., Pins, M.R., et al. Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma. Ann. Surg. 1993, 217(1), p. 41-47.

3. Ohashi K, M.Y., Maruyama M. Four cases of mucin-producing cancer of the pancreas on specific findings of the papilla of Vater. Prog. Dig. Endoscopy 1982, 20, p. 348-351.

4. Sohn, T.A., Yeo, C.J., Cameron, J. L. et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann. Surg. 2001, 234(3), p. 313-321.

5. Yamaguchi, K.,Tanaka, M. Intraductal papillary-mucinous tumor of the pancreas: a historical review of the nomenclature and recent controversy. Pancreas 2001, 23(1), p. 12-19.

6. Adsay, N. V. The “new kid on the block”: Intraductal papillary mucinous neoplasms of the pancreas: current concepts and controversies. Surgery 2003, 133(5), p. 459-463.

7. Hruban, R.H., Takaori, K., Klimstra, D.S., et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am. J. Surg. Pathol. 2004, 28(8), p. 977-987.

8. Salvia, R., Fernandez-Del Castillo, C., Bassi, C. et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann. Surg. 2004, 239(5), p. 678-685.

9. Fernandez-Del Castillo, C., Targarona, J., Thayer, S.P. et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch. Surg. 2003, 138(4), p. 427-423.

10. Sohn, T.A., Yeo, C.J., Cameron, J.L. et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann. Surg. 2004, 239(6), p. 788-797.

11. Kitagawa, Y., Unger, T.A., Taylor, S. et al. Mucus is a predictor of better prognosis and survival in patients with intraductal papillary mucinous tumor of the pancreas. J. Gastrointest. Surg. 2003, 7(1), p. 12-18.

12. Sugiyama, M., Izumisato, Y., Abe, N. et al. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br. J. Surg. 2003, 90(10), p. 1244-1249.

13. Balzano, G., Zerbi, A., Di Carlo, V. Intraductal papillary mucinous tumors of the pancreas: incidence, clinical findings and natural history. JOP 2005, 6(1 Suppl), p. 108-111.

14. Brugge, W.R. Cystic pancreatic lesions: can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment? Endoscopy 2006, 38(Suppl 1), p. S40-47.

15. Strobel, O., Z’graggen, K., Schmitz-Winnenthal, F.H. et al. Risk of malignancy in serous cystic neoplasms of the pancreas. Digestion 2003, 68(1), p. 24-33.

16. Le Borgne, J., De Calan, L., Partensky, C. and the French Surgical Association. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. Ann. Surg. 1999, 230(2), p. 152-161.

17. Tseng, J.F. Management of serous cystadenoma of the pancreas. J. Gastrointest. Surg. 2008, 12(3), p. 408-410.

18. De Calan, L., Levard, H., Hennet, H., Fingerhut, A. Pancreatic cystadenoma and cystadenocarcinoma: diagnostic value of preoperative morphological investigations. Eur. J. Surg. 1995, 161(1), p. 35-40.

19. Suzuki, Y., Atomi, Y., Sugiyama, M. et al. Cystic neoplasm of the pancreas: a Japanese multiinstitutional study of intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas 2004, 28(3), p. 241-246.

20. Repák, R., Rejchrt, S., Bártová, J. et al. Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration with cyst fluid analysis in pancreatic cystic neoplasms. Hepatogastroenterology 2009, 56(91-92), p. 629-635.

21. Ahmad, N.A., Kochman, M.L., Lewis, J.D., Ginsberg, G.G. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas? Am. J. Gastroenterol. 2001, 96(12), p. 3295-3300.

22. Šálek C. Klasifikace a etiopatogeneze cystických tumorů pankreatu. Bulletin HPB, 2007, 15(1), p. 33-34.