Evaluation and Management of Pancreatic Cystic Lesions

INTRODUCTION Pancreatic cysts are now being encountered by primary and specialty care physicians with ever increasing frequency due to the widespread use of high quality cross-sectional imaging (1,2). The majority of these cystic lesions are incidental asymptomatic findings, and therefore can present both diagnostic and therapeutic dilemmas. The differential diagnosis of cystic pancreatic lesions includes both inflammatory lesions, such as pseudocysts and abscesses that follow pancreatitis, as well as neoplastic lesions. Cystic neoplasms of the pancreas are composed of a variety of neoplasms with a wide range of malignant potential. They account for approximately 10%–15% of cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms (3–6). These neoplasms include serous cystadenomas (32%– 29%), mucinous cystadenomas (10%–45%), intraductal papillary mucinous neoplasms (IPMNs) (21%–33%), and mucinous cystadenocarcinomas (<1%) (7,8). Since pancreatic cystic neoplasms represent a spectrum of benign, pre-malignant, and malignant tumors, differentiating among the various lesions is clinically important. This article represents a review of the literature on this topic and attempts to summarize the latest consensus on diagnosis and management.