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3: MED2 Y3 - Gastrointestinal [7] > [28] Pancreatic Cysts > Flashcards

[28] Pancreatic Cysts Flashcards

1
Q

What are pancreatic cysts?

A

Collections of fluid that form within the pancreas

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2
Q

What is happening to the incidence of pancreatic cysts?

A

It is increasing

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3
Q

How are most pancreatic cysts identified?

A

Incidentally on imaging

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4
Q

What % of individuals going for an abdominal MRI scan will have an incidental pancreatic cyst identified?

A

Around 15%

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5
Q

What can pancreatic cysts be divided into?

A 
True cysts (non-inflammatory) - what this deck is about 
Pseudocysts (inflammatory)
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6
Q

What can pancreatic cysts be classified based on?

A

Secretions
Histology
Risk of malignancy

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7
Q

What pancreatic cysts have a higher risk of malignancy?

A

Intraductal papillary mucinous neoplasms
Mucinous cystic neoplasms
Solid pseudopapillary neoplasm
Cystic pancreatic neuroendocrine tumour

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8
Q

What pancreatic cysts have a lower risk of malignancy?

A

Serous cystic adenoma
Simple cyst
Mucinous non-neoplastic cyst
Lymphoepithelial cyst

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9
Q

What are intraductal papillary mucinous neoplasms associated with?

A

Pancreatic duct malignancies

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10
Q

Where are intraductal papillary mucinous neoplasms often found?

A

At the main or branch pancreatic ducts

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11
Q

Where are mucinous cystic neoplasms often found?

A

In the body or tail of the pancreas

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12
Q

What % of mucinous cystic neoplasms are cancerous on diagnosis?

A

30%

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13
Q

What are the 70% of mucinous cystic neoplasms that are not cancerous on diagnosis considered to be?

A

Pre-cancerous

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14
Q

Who are solid pseudopapillary neoplasms most commonly found in?

A

Young Asian and Afro-Caribbean women

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15
Q

What is the prognosis of solid pseudopapillary neoplasms?

A

They have an excellent prognosis post-resection

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16
Q

What are the features of cystic pancreatic neuroendocrine tumours?

A

Rare
Frequently non-functional
Associated with MEN 1 syndrome

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17
Q

What are serous cystic adenomas?

A

Serous benign lesions

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18
Q

How do serous cystic adenomas typically look in imaging?

A

Honeycombed appearance

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19
Q

Where are serous cystic adenomas most commonly found?

A

In tail and body of pancreas

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20
Q

What is a simple cyst?

A

A true epithelial cyst, always benign lesions

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21
Q

What are mucinous non-neoplastic cysts?

A

Mucin producing lesions

22
Q

Is dysplasia found in mucinous non-neoplastic cysts?

A

Rarely

23
Q

How does a lymphoepithelial cyst appear on histology?

A

Sheets of lymphocytes, rarely with dysplastic cells associated

24
Q

What % of cases of pancreatic cysts are asymptomatic?

A

70%

25
Q

What are the presenting complaints for symptomatic pancreatic cysts?

A

Abdominal pain or back pain
Post-obstructive jaundice
Vomiting

26
Q

How do symptomatic pancreatic cysts cause abdominal pain or back pain?

A

From mass effect or compression symptoms

27
Q

How can pancreatic cysts present if they become infected?

A

They can present with systemic features

28
Q

How can pancreatic cysts present if they become malignant and metastasise?

A

May present with systemic features of malignancy, e.g. weight loss, loss of appetite, change in bowel habits

29
Q

What may be found on examination in pancreatic cysts?

A

Examination will likely be unremarkable, but on rare occasions there may be a tender abdomen, a palpable mass, or abdominal distention

30
Q

What are the differential diagnoses for pancreatic cysts?

A

Pancreatic pseudocyst

31
Q

What is a pancreatic pseudocyst?

A

A collection of fluid within the pancreatic tissue

32
Q

When does a pancreatic pseudocyst typically form?

A

Following pancreatitis

33
Q

Why may a pancreatic pseudocyst form following pancreatitis?

A

The inflammatory reaction produces a necrotic space in the pancreas that fills with pancreatic fluid

34
Q

Why is a pancreatic pseudocyst so named?

A

Because it lacks epithelial or endothelial cells surrounding the collection

35
Q

How are pseudocysts discovered?

A

They tend to be asymptomatic, so are usually picked up on imaging

36
Q

What investigations may be required for pancreatic cysts being worked up for further management?

A

Baseline blood tests, including FBC, U&Es, and LFTs

CA19-9

37
Q

Why might CA19-9 be done in pancreatic cysts?

A

To monitor progression of the disease

38
Q

What do NICE guidelines suggest to further assess and evaluate pancreatic cysts?

A

Pancreatic protocol CT scan or magnetic resonance cholangiopancreatography

39
Q

How can imaging be useful for determining prognosis?

A

It can be used to stratify those cysts that are low risk versus those that are high riks

40
Q

What are the low risk features of pancreatic cysts that can be seen on imaging?

A

Cyst diameter <3cm
Cystic morphology with central calcification
(Asymptomatic)

41
Q

What are the high risk features of pancreatic cysts that can be seen on imaging?

A

Cyst diameter >3cm
Main pancreatic duct dilation greater than 10mm
Enhancing solid component
Non-enhancing mural nodule

42
Q

What may be warranted based on features identified on initial imaging in pancreatic cysts?

A

Further investigations, either via complete resection (especially if high risk, or further testing through endoscopic US scan with fine needle aspiration

43
Q

Why is endoscopic US scan with fine needle aspiration done in pancreatic cysts?

A

It allows for a biopsy sample to be obtained, which is useful in determining both low and high grade lesions

44
Q

What is the purpose of discussion of pancreatic cysts in the MDT?

A

To plan for any further imaging, follow-up, or surgical intervention

45
Q

What is true of the majority of pancreatic cysts?

A

They are benign, and can therefore be left alone with surveillance only

46
Q

What is the first-line treatment for high-risk pancreatic cysts?

A

Resection, where feasible

47
Q

How are high-risk pancreatic cysts followed up after resection?

A

In most cases, follow-up MRI scan every 2 years

48
Q

How often is surveillance done in low-risk pancreatic cysts?

A

5 yearly

49
Q

What should be done if there is any rapid growth or suspicions during surveillance for pancreatic cysts?

A

The cyst should be re-investigated and managed appropriately

50
Q

What is the prognosis of pancreatic cysts?

A

Highly dependant on the subtype of the cyst, and the degree of invasion

3: MED2 Y3 - Gastrointestinal [7] (44 decks)

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