Pancreatic Cyst
Fluid-filled sacs in or on the pancreas that may be benign or have malignant potential.
Overview
Pancreatic cysts are increasingly detected due to widespread imaging. They range from benign (pseudocysts, serous cystadenomas) to premalignant (IPMNs, mucinous cystic neoplasms). Accurate classification determines whether surveillance or surgery is needed.
Causes
- Pseudocyst (following acute pancreatitis)
- IPMN (Intraductal Papillary Mucinous Neoplasm)
- Mucinous cystic neoplasm (MCN)
- Serous cystadenoma (benign)
- Solid pseudopapillary neoplasm
Risk Factors
- Previous pancreatitis (pseudocysts)
- Age over 60 (IPMNs)
- Female gender (MCN, SPN)
- No modifiable risk factors for most cystic neoplasms
Symptoms
Diagnosis
- CT/MRI pancreas
- EUS with cyst fluid analysis (CEA, amylase, cytology)
- MRCP (ductal communication)
- Main duct vs branch duct IPMN classification
- Fukuoka/AGA guidelines for surveillance
Treatment Options
Surgical Treatment
Surgery is recommended for: main-duct IPMN, branch-duct IPMN with high-risk features (mural nodule, main duct dilation >10mm, positive cytology), MCN (all should be resected), and symptomatic pseudocysts not resolving. Distal pancreatectomy for body/tail, Whipple for head lesions.
Recovery
Distal pancreatectomy: 5-7 days hospital stay. Whipple: 7-10 days. Post-surgery: pancreatic enzyme supplements if needed. Surveillance for remaining pancreas if IPMN.
Prevention
- No known prevention for cystic neoplasms
- Prevent pancreatitis to avoid pseudocysts (limit alcohol)
- Follow surveillance guidelines for incidental cysts
Frequently Asked Questions
Are all pancreatic cysts dangerous?
How often should pancreatic cysts be monitored?
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