Pancreatic Cysts

Pancreatic cysts are fluid collections outside of the normal pancreatic duct system.  The marked improvement in abdominal imaging techniques has led to the unexpected identification of small cysts of unknown significance.  The challenge among experts is to decide which of these cysts are concerning (and might have malignant potential) and which are benign.

There are many different types of cysts, with the most common in adults with a history of pancreatitis being “pseudocysts” which are a benign condition.  A list of the different types of cysts by Drs Federle and Mcgrath provides a convenient organization:

Pancreatic Cystic Masses (1)

Congenital

  • True (epithelium-lined) cyst
  • Syndromes causing multiple cysts
    • Autosomal dominant polycystic disease
    • von Hippel-Lindau
    • Cystic fibrosis
  • Inflammatory
  • Pseudocyst
  • Pancreatic abscess
  • Hydatid cyst

Neoplastic

  • Benign
    • Serous (microcystic) cystadenoma
    • Cystic teratoma
    • Lymphoepithelial cyst
  • Malignant or potentially malignant
    • Mucinous cystic neoplasm
    • Solid and papillary epithelial neoplasm

Other (tumors that may have a cystic component)

  • Intraductal papillary mucinous neoplasm (IPMN)
  • Islet cell tumor
  • Anaplastic carcinoma
  • Metastases to pancreas (eg, ovarian cystadenocarcinoma)

1. Federle MP, McGrath KM. Cystic neoplasms of the pancreas. Gastroenterol Clin North Am. 2007 Jun;36(2):365-76, ix.

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