Cystic Neoplasms of the Pancreas

Cystic neoplasm in the body of the pancreas, managed conservatively with periodic screening.

What are True Cysts of the pancreas?

True cysts are very rare and are defined pockets of fluid collection around the pancreas that are lined by epithelium. They are not the commonest cysts of the pancreas. Pseudocyst or “false” cysts of the pancreas are lined by granulation tissue and often occur as sequelae of acute or chronic pancreatitis. These cysts often contain a mixture of pancreatic juices mixed with old blood that had leaked out from the ruptured or inflamed pancreas.

What are commonest forms of true cysts?

The commonest forms are Mucinous and Serous cystadenomas. The other infrequent cystic tumors include papillary cystic tumors, cystic neuroendocrine tumor, cystic teratoma, lymphangioma, hemangioma, and paraganglioma.

Mucinous type are the most common cystic pancreatic neoplasms and often are seen in women in their 60’s. Abdominal pain, weight loss, early satiety, nausea and vomiting are among the most frequently reported symptoms. But most are asymptomatic and are discovered incidentally during a routine check up when an Xray or a scan is ordered. While some maybe benign, a good percentage of these may be premalignant or malignant and therefore need thorough evaluation.

At the Liver and Pancreas Center our team of surgeons working closely with the gastroenterologist come up with an individualized plan based on the CT or MRI scan and the ERCP with an EUS. Cystic fluid is usually aspirated when possible safely and an analysis of the fluid to rule out malignant potential is done in the laboratory.

Is surgery absolutely necessary?

No. If the fluid analysis reveals it to be benign and the cyst is less than 4 cm in size or asymptomatic, then they can be watched conservatively with your physician, who should keep a close eye on it and scan you on a periodic basis.

When is surgery necessary?

If there is a remote possibility that these could have malignant potential, then it is prudent these be removed surgically. Treatment of cystic pancreatic neoplasms depends on the tumor's size, location, type, and extent. The various operations depending on its location include:

Can these surgeries be performed laparoscopically or robotically?

Yes. Decisions are made on a on a case by case basis upon reviewing the CT or MRI scans to ensure the quality of the operation is not compromised.