Cystic Tumors of the Pancreas
A fluid filled cyst may develop in pancreas due to several reasons. The pancreatic cyst requires highest attention as they may be precursor of pancreatic cancer. Pancreatic cysts may be present in over 2 percent of patients who undergo a CT scan for unrelated reasons, Appropriate diagnosis of these tumors is important since surgical removal of the tumor is associated with a high cure rate.Unresected (surgically not removed) tumors particularly of the mucinous cystadenoma type can lead to invasive pancreatic cancer, a potentially fatal disorder.
Pancreatic cyst can be divided into two broad categories:-
Non-Neoplastic ( non cancerous)
Neoplastic ( potential to become cancer)
Pancreatic psuedocyst are non neoplastic cyst that can arise in patient who have previous episode of pancreatitis. These cyst are not true cyst as they dont have real cyst wall. Pancreatic psuedocyst arises from inflammation of pancreas either due to alcoholic pancreatitis, gallstone pancreatitis or injury to pancreas. Most of the time, these cyst resolve on its own. Often times, these cyst enlarges and cause symptoms of obstruction, abdominal pain and bleeding at which time , further surgical or endoscopic treatment may be needed.
Neoplastic cyst :-
The four main types of neoplastic pancreatic cyst include the following.
• Serous cystic tumors
• Mucinous cystic neoplasms (MCNs)
• Intraductal papillary mucinous neoplasms (IPMNs)
• Solid pseudopapillary neoplasms (SPNs)
Mucinous cystadenomas are the most frequent cystic tumors of the pancreas and comprise approximately 50% of all cystic tumors. While these tumors are usually benign, the majority if left untreated will probably evolve to a malignant tumor. Mucinous cystic neoplasms (MCNs) occur exclusively in women and are most commonly discovered after the age of 40 years.
These cyst are usually diagnosed with CT scan or MRI, in many cases the study is diagnostic. Ocassionally additional studies may be required to obatain information regarding the pancreatic cyst.
Endosopic Ultrasound is the newer appraoch where the cyst can be evaluated directly using an ultrasound attached to a Endoscope. This also allows an opportunity to study the cyst by aspirating fluid for cytology and fluid chemistry.
When the diagnosis of a serous cystadenoma (SCA) is made with a endoscopic Ultrasound, few options are available based on symtoms. If the cyst is symptomatic, resection is advised. For asymptomatic serous cystadenoma, CT scan may be repeated as malingnant transformation into adenocarcinoma is exceedingly rare. Resection of SCA is indidated if the cyst is symptomatic or if the diangosis is in doubt.
Solid pseudopapillary neoplasms :-
These tumors have both solid and cystic component and have higher malingant potential. There is a 15--17 % risk of malingnat transforamtaion in solid psuedopapillary neoplasms an surgical resection is needed. These tumors have good prognosis even if malignant potential is seen in these tumors at final biopsy report.
Based on the diagnositic studies, the cyst in the pancreas can be classified as pre malignant to benign. Some of the test that help determining this is CT scan and Endoscopic Ultrasound.
Benign cyst can be carefully watched without any further surgical intervention
Premalignant cyst require surgical resection.
Cyst located in the head of pancreas may require Pancreaticoduodenectomy ( Whipple procedure)
Cyst located in the body/ tail of pancreas will require distal pancreatectomy
Please call us at (813) 879-5010 seek further treatment of pancreatic cysts.