Cystic Neoplasms of the Pancreas

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Cystic Neoplasms of the Pancreas
O.Benjaminov Rabin Medical Center Beilinson
Campus benjaminovo_at_clalit.org.il
Paris 2008
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Becourt in 1830, "the size of a childs head
and composed of very strong fibrous walls
Becourt PJ BG, Recherches sur le pancreas ses
functions et ses alterations organique.
Strasbourg Levrault 1830
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Cystic Neoplasms of the Pancreas
v Serous cyst v Mucinous Cyst v IDPMT v Other
rare cystic tumors v Incidentalomas --
Pancreatic pseudocysts
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• Most common of pancreatic cystic neoplasms
• 95 women, 4th 6th decade
• 70-90 pancreatic tail or
• distal body
• Usually multilocular (six or
• more cysts gt 2 cm).
• May be unilocular.
• Malignant potential
• May have scattered/peripheral Ca (18).
• Malignancy correlates with multilocularity, mural
  nodules,
• thick walls, thick septations and
  calcifications.

• Sahani, D. V. et al. Radiographics
  2005251471-1484

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Serous (micro) Cystadenomas of the Pancreas

• Second most common cystic neoplasm of pancreas
• Benign tumor
• Women gt 50 y.o
• Predilection for the
• pancreatic head
• Multiple cysts (0.2-2.0 cm) avg. 10 cm.
• central stellate scar that can calcify (Ca38)

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Association between VHL and SCA
15-30
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VHL Von Hippel Lindau
1
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potential malignancy risk - 3 Since 1989 673
SCA (71 series, 40 case reports 10 CA)
Digestion 20036824-33
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macrocystic serous adenoma and micro-macro
(mixed) serous cystadenoma
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• 1982 Ohaishi (triad)
• Mucin producing tumors
• Wirsung dilatation
• Protruding papilla

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• MF, 60-80 y.o
• Incidental diagnosis 30, most are
• symptomatic
• Pancreatitis like pain, diabetes
• Malignant potential, more curable
• than pancreatic adenocarcinoma

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1/2
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2/2
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1/2
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2/2
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Solid and papillary epithelial neoplasms
(Hamoudi Tumor)
Young females (95) 25 y.o Low malignant
potential Large avg. 9-10 cm Fibrous capsule,
hemorrhage, necrosis
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Cystic Neoplasms of the Pancreas
Cystic degeneration
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Cystic Neoplasms of the Pancreas
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Cystic Neoplasms of the Pancreas
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Cystic Neoplasms of the Pancreas
Lymphoma
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Incidentalomas

• Incidence 0.2-0.7 (autopsy 24)
• Natural history data limited
• More than half of them are either malignant
• or pre-malignant. They are unlikely to be
  pseudocysts
• however cysts lt 2cm are unlikely to cause
  morbidity or mortality

Arch Surg. 2003 138 427-434 Annals Surg
2004239651 AJR 200518420-23 Am J
Gastroenterol 2007 102 2339-2349
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Algorithm for the management of incidental
pancreatic cysts
MGH 2003
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Algorithm for the management of incidental
pancreatic cysts
Mayo Clinics 2005
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The American Society for Gastrointestinal
Endoscopy (ASGE)
Cystic lesions of the pancreas, even when found
incidentally,require diagnostic evaluation
regardless of size because they may represent
malignant or premalignant neoplasm. March
2006 also supported by American College of
Gastroenterology Oct . 2007
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Cystic Neoplasms of the Pancreas
Conclusions
In the absence of clear evidence of previous
pancreatitis cystic lesions are considered
neoplastic. Imaging plays an important role in
defining architecture and relation to surrounding
organs as well as communication with the
pancreatic ductal system. A multimodality
approach should be taken. Incidental cystic
lesions management controversial for lesions
asymptomatic lt 2 cm a conservative approach is
reasonable
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Merci ???? Thank You
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Epidemiology of Cystic Pancreatic
Tumors Pseudocysts account for gt 70 of all
cystic lesions Cystic neoplasms thought to
account for 20 of cystic lesions Cystic
neoplasms represent only 1 of all pancreatic
neoplasms. This figure may be incorrect as many
asymptomatic cystic tumors do not have surgery
or FNA The prevalence of the more common cystic
tumors Mucinous cystic neoplasm (MCN) 10 - 45
Intraductal Papillary Mucinous Tumor (IPMT) 21 -
33 Serous cystadenoma 32 - 40 Solid
pseudopapillary tumor (SPT) lt 10 Others are
rare acinar cell cancer lt 1
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Cystic Neoplasms of the Pancreas
Cystic Islet Cell Tumor
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Cystic Neoplasms of the Pancreas
Pancreatic Metastases
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Cystic Neoplasms of the Pancreas
Cystic lymphangioma
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Simple Cyst
Mucinous Cyst
Mucinous Cyst
Pseudocyst
Serous Cyst
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Slide 13
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Minerva Chir 2004 59185-207
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Focal PancreatitisFP/FP
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