Non-reassuring findings in adjacent independent pancreatic cysts

The higher number of imaging examinations (CT and magnetic resonance imaging) being performed and their improved definition are increasing the number of incidental diagnoses of pancreatic cystic lesions. It is therefore necessary to differentiate benign cysts from those with a potential for malignancy that may require surveillance or further treatment. To do so, lesions that present risk stigmata (worrisome features) must be stratified, integrating the findings with the patient age, comorbidities, and performance status. We describe a case of difficult interpretation of the risk stigmata because there were 2 adjacent independent cysts of distinct nature. We emphasize the role of EUS with FNA as crucial for decision-making at the multidisciplinary meeting.