Cystic Neoplasms of the Pancreas

Pancreatic cystic neoplasms are uncommon, but are being detected at an increased rate in the current era of sophisticated abdominal imaging. The selection of appropriate treatment depends on the ability to distinguish benign from malignant cysts. The most common clinical mistake is to treat a cystic neoplasm as a benign pseudocyst. The identification of a cyst as a cystic neoplasm should be suspected on clinical grounds, but the differentiation from a benign cyst is often difficult based on clinical features and imaging alone. Analysis of cystic fluid for tumor markers and cytology should be considered, using newer approaches such as endoscopic ultrasound-guided fine needle aspiration (FNA), in those patients in whom this information may guide appropriate therapy. Surgical excision of a cystic pancreatic neoplasm is the treatment of choice in patients fit for surgery. Inappropriate treatment of these lesions as pseudocysts, by radiographic, endoscopic, or surgical drainage, is to be avoided. Resection of the lesion should be seriously considered even in the absence of symptoms, as these lesions have malignant potential and are often curable.