Cystic tumours of the pancreas are rare and incidental detections on diagnostic imaging. They are asymptomatic, small and some types may have a potential for malignancy. They are fluid filled sacs with abnormal fluids produced by the lining of the tumour. Neoplastic and non-neoplastic are two broad categories of pancreatic cysts. The classification of the cysts is extremely important for their treatment. Symptomatic neoplastic cysts require therapy if they have a potential to turn malignant. Certain types of Cysts that are not removed have a potential to lead to invasive pancreatic cancer, which is fatal. It is important to differentiate tumours from pancreatic pseudocysts due to chances of misdiagnosis and inappropriate treatment.
Most frequent type of pancreatic tumours
Constitute of approximately 50% of all cystic lesions
They are usually benign
If left untreated evolve into malignant tumours
Females are most affected: 80%; most affected younger female patients
Diagnostic CT scan: evaluation based on appearance
Endoscopic Ultrasound (EUS): Is a very useful tool in differentiating types of cystic neoplasms. Cyst fluid analysis is indicated in patients with doubtful diagnosis
Treatment of choice: surgical removal
Selection of surgery depends on the location of the tumour
Surgeries considered: Whipple procedure (for tumour in the head of the pancreas), distal pancreatectomy (tumours in the tail of the pancreas) with preservation of spleen, Median Pancreatectomy in tumors locatesd in the neck (3 cm or less in size)
Second most common type of pancreatic lesion also known as microcystic adenoma
They are honeycombed in appearance
Lesion is always benign
Unlikely to progress into cancer
Diagnostic CT scan and EUS are preferred
Treatment with long term follow-up and observation
Intraductal Papillary Mucinous neoplasms (IPMN)
Arises from the Lining of the pancreatic duct
Can Affect the head of the pancreas or can be multifocal
Large volumes of thick mucous is produced by the cancer cells
Recurrent attacks of pancreatitis due to mucosal blockage of pancreatic ducts
Affects older men > 66 years of age with history of heavy smoking
MRCP: Is the preferred non invasive diagnostic test
Diagnostic ERCP: enlarged opening of pancreatic duct into ampulla of Vater; mucosal extrusion from the ampulla
Choice of surgery: resection of tumour. In cases of multifocal disease removal of the entire pancreas may be needed.
Solid and Pseudopapillary Neoplasm
Very rare tumors which exclusively affects young females
It is potentially malignant
Most common ly occur in the head of pancreas.
Can grow to large sizes by the time of diagnosis as it is usually asymptomatic
Diagnosis is made by CT scan and EUS.
Dr. Deepak Varma has extensive experience in the treatment of cystic tumours of the pancreas.