[Incidentaloma of the pancreas]

The term incidentaloma refers to an asymptomatic mass detected accidentally during a technical examination, mostly by radiological methods, when performed in a patient examined for other conditions or situations. Surgery is the adequate therapy for adrenal incidentalomas with increasing size, a size bigger than 4 cm at detection, hormone-activity or malignant histology. Incidentalomas of the adrenal and thyroid gland are still often dismissed because they are common and mostly benign. Incidentalomas of the pancreas are distinct and less frequent. At present, no evidence-based guidelines exist for the management of asymptomatic pancreatic lesions. Only few clinical studies describe pancreatic incidentalomas, however these studies claim a malignant histology of up to 30 % and of up to 50 % for pre-malignant incidentalomas of the pancreas. Thus, we recommend an early resection of pancreatic incidentalomas with a size of > 2 cm, in younger patients without concomitant diseases or increased operative risk, with a malignant histology, and with mucinous cells and increased tumour markers in blood samples. Organ-saving procedures or radical pancreatectomy are possible while both methods are safe and have a very low complication risk. The surgical resection of pancreatic incidentalomas offers a significant advantage in survival when the total collective of affected individuals is taken into account.