The importance of cyst fluid analysis for differentiation of pancreatic cyst

Cystic abnormalities of the pancreas encompass a wide variety of lesions ranging from the non-malignant pseudo-cyst to neoplastic lesions. Although cystic neoplasms of the pancreas are rare, differentiation is important in determining the proper treatment. A 55-year-old female presented with a cystic abdominal mass. Her computed tomography scan showed a cystic mass of 102 x 99 x 97 mm which was well-circumscribed and homogeneous with few thin septations and mild contrast enhancement of the fibrous wall located in the body of the pancreas. Percutaneous diagnostic aspiration of the cyst fluid was performed under ultrasonic guidance for proper diagnosis and management, which revealed a CEA greater than 200 ng/ml (0-3) and amylase within normal limits 30 U/L (< or = 100). High CEA and normal amylase values supported the diagnosis of mucinous cystadenoma rather than pseudo-cyst. With these findings, the patient underwent distal pancreatectomy with splenectomy. Pathological analysis revealed a mucinous cystadenoma of the pancreas. This report is a confirmation that cyst fluid analysis can provide a pre-operative classification of these diagnostically difficult lesions.