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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 a 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.

Types

Mucinous cystadenoma

  • Most frequent type of pancreatic tumours
  • Constitute 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 a tumour
  • Surgeries considered: Whipple procedure (for a tumour in the head of the pancreas), distal pancreatectomy (tumours in the tail of the pancreas) with preservation of spleen, Median Pancreatectomy in tumors located 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 are produced by the cancer cells
  • Recurrent attacks of pancreatitis due to mucosal blockage of pancreatic ducts
  • Affects older men > 66 years of age with a 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 commonly occur in the head of the 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.

Our team has extensive experience in the treatment of cystic tumours of the pancreas.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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