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Cystic Tumours Of The Pancreas

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.

Tumors of pancreas

Types

Mucinous cystadenoma

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)

Serous cystadenoma

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.

Surgical removal is essential. Surgery is often complex, because of the size and location of the tumour.

Dr. Deepak Varma has extensive experience in the treatment of cystic tumours of the pancreas.