Pancreatic Cysts

Question 1

What are pancreatic cysts?

Answer 1

Collections of fluid that form within the pancreas

Question 2

Epidemiology

Answer 2

Increasing incidence

Most cysts are found incidentally on imaging

15% of individuals going for an abdo MRI scan will have incidental pancreatic cyst identified

Question 3

What are pancreatic cysts divided into?

Answer 3

True cysts = non-inflammatory

Pseudocysts = infalmmatory

These flashcards use pancreatic cyst and true cysts interchangably.
It will not discuss pseduocsyts

Question 4

Anatomy of the pancreas

Answer 4

Question 5

How can pancreatic cysts be classified?

Answer 5

By secretions

Histology

Risk of malignancy

Question 6

Cysts with high risk of malignancy

Answer 6

Intraductal Papillary Mucinous Neoplasm (Main or branch of panreatic ducts)

Mucinous Cystic Neoplasm (Body or tail)

Solid Pseudopapillary Neoplasm (Most common in young asian and afro-caribbean women)

Cystic Pancreatic Neuroendocrine Tumour (MEN1)

Question 7

Low risk pancreatic cysts

Answer 7

Serious cystic adenoma (Serous benign lesion with a honeycombed appearance on imaging, found in tail and body)

Simple cyst (always benign)

Mucinous Non-Neoplastic cyst (Mucin producing)

Lymphoepithelial cyst

Question 8

Clinnical features

Answer 8

70% are asymptomatic

Abdo pain and/or back pain from mass effect and compression symptoms

Post-obstructive jaundice

Vomiting

Cyst can also become infected and present with systemic features

Systemic features of malignancy if tehre is malignancy

Question 9

Examination findings

Answer 9

Most often unremarkable

Tender abdomen, palpable mass or abdo distension might be found.

Question 10

Dx

Answer 10

Pancreatic pseudocyst

Question 11

Ix

Answer 11

Blood tests like FBC, U&Es, LFTs

CA 19-9 levels can be helpful to monitor progression.

Pancreatic protocol CT scan or MRCP can be used to further assess and evaluate pancreatic cysts.

Question 12

Factors suggesting low risk on imaging

Answer 12

Cyst diameter < 3cm

Cystic morphology with central calcification

Asymptomatic

Question 13

Factors suggesting high risk on imaging

Answer 13

Cyst diameter >3cm

Main pancreatic duct dilatation greater than 10mm

Enhancing solid component

Non-enhancing mural nodule

Question 14

Based on features identified on initial management, further investigation might be warranted.

Which?

Answer 14

Complete resection if high risk

Endoscopic US scan with fine needle aspiration might be done to obtain a biopsy sample to make sure what ind of lesion it is.

Question 15

General management

Answer 15

MDT to plan for further imaging, follow-up, or surgical intervention.

Majority are benign so only surveillance is needed usually.

Question 16

Treatment of high-risk cysts.

Answer 16

Resection where feasible is first line.

Follow-up MRI scan every 2 years should be done.

Question 17

Follow-up of low risk cysts

Answer 17

Surveillance every 5 years.

Any rapid growth of suspicions during surveillance should be re-investigated and managed appropriately.