KTPH Hepato–Pancreato–Biliary Surgery Service (HPB)
Pancreatic Cysts
There are many types of pancreatic cysts that are commonly seen on imaging. Some cyst types can harbour or develop into cancers.
In general, serous cystic pancreas lesions and pseudocysts have no risk of developing into cancer and do not require an operation to remove the cyst or a portion of the pancreas.
It is recommended to remove cysts suspected to have mucinous cystadenoma, solid pseudopapillary epithelial neoplasm, or neuroendocrine lesions, in medically fit patients.
| Pancreatic Cystic Lesion | Age - Gender | Imaging | |
 | Serous Cystadenoma "Benign" Rare malignant potential 0.6-3% | 75% women, 60-70yo, Grandma | Lobulated, microcystic polycystic, honeycomb, and oligocystic; 18% calcified central scar |
 | Mucinous Cystadenoma Malignant Potential Invasive 17.5% | 99% women, 40-50yo, Mother | Macrocystic; Usually 1 cyst; 25% peripheral calcifications; 95% in tail and body |
 | Solid Pseudopapillary Epithelial Neoplasm Malignant 15% | 90% women, 10-30yo, Daughter | Well-encapsulated heterogeneous areas of necrosis, hemorrhage, and cystic change |
 | Main Duct IPMN Malignant Potential Invasive 43% (5 yr surv 31-54%) | M=W, 60-80yo | Dilated pancreatic duct; Protruding papil of Vater |
 | Side-Branch IPMN Malignant Potential Invasive 18.5% annual rate of progression 1.4–6.9% | M=W, 60-80yo | Bunch of grapes; Connection to pancreatic duct |
Intraductal Papillary Mucinous Neoplasms (IPMN) are changes in the cells lining the pancreatic ducts and each subtype has different risks for transforming into a cancer: main duct IPMN carries a higher risk.
Imaging is used to determine its type, size and internal characteristics ("worrisome features": enhancing nodules, thickened/enhancing walls, main pancreatic duct >5mm, abrupt change in calibre, distal pancreatic atrophy, lymphadenopathy, elevated serum CA19-9, cyst growth rate >5mm in 2 years) and recommendations are given based on guidelines for removal or surveillance.
At times it cannot be determined from the imaging alone which type of cyst is present and follow up scans or an endoscopic ultrasound with sampling may be recommended.
