Classification of pancreatic cysts
- Asif Khalid, MD
Asif Khalid, MD
- Associate Professor of Medicine
- University of Pittsburgh, VA Pittsburgh Health Care System
- Kevin McGrath, MD
Kevin McGrath, MD
- Professor of Medicine
- University of Pittsburgh
Pancreatic cysts are diagnosed with increasing frequency because of the widespread use of cross-sectional imaging. Pancreatic cysts may be detected in over 2 percent of patients who undergo abdominal imaging with multidetector computed tomography or magnetic resonance imaging for unrelated reasons. This frequency increases with age [1,2].
Pancreatic cysts can either be neoplastic (eg, intraductal papillary mucinous neoplasms) or non-neoplastic. Accurate cyst categorization is important, since non-neoplastic cysts require treatment only if symptomatic, whereas some of the pancreatic cystic neoplasms have significant malignant potential and should be resected.
This topic will review the classification of pancreatic cysts. An overview of pancreatic cystic neoplasms and issues related to pancreatic inflammatory fluid collections and intraductal papillary mucinous neoplasms of the pancreas are discussed separately:
●(See "Pancreatic cystic neoplasms".)
- Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008; 191:802.
- de Jong K, Nio CY, Hermans JJ, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 2010; 8:806.
- Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004; 239:651.
- Sey MS, Teagarden S, Settles D, et al. Prospective Cross-Sectional Study of the Prevalence of Incidental Pancreatic Cysts During Routine Outpatient Endoscopic Ultrasound. Pancreas 2015; 44:1130.
- Fernández-del Castillo C, Targarona J, Thayer SP, et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003; 138:427.
- Hammel PR, Vilgrain V, Terris B, et al. Pancreatic involvement in von Hippel-Lindau disease. The Groupe Francophone d'Etude de la Maladie de von Hippel-Lindau. Gastroenterology 2000; 119:1087.
- Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102.
- Kosmahl M, Egawa N, Schröder S, et al. Mucinous nonneoplastic cyst of the pancreas: a novel nonneoplastic cystic change? Mod Pathol 2002; 15:154.
- Ramsden KL, Newman J. Lymphoepithelial cyst of the pancreas. Histopathology 1991; 18:267.
- Nasr J, Sanders M, Fasanella K, et al. Lymphoepithelial cysts of the pancreas: an EUS case series. Gastrointest Endosc 2008; 68:170.
- World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System, Aaltonen LA, Hamilton SR (Eds), IARC Press, Lyon, France 2000.
- Zamboni G, Kloeppel G, Hruban RH, et, al. Mucinous cystic neoplasms of the pancreas. In: World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System, Aaltonen LA, Hamilton SR (Eds), IARC Press, Lyon, France 2000. p.234.
- Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery 2012; 152:S4.
- Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol 1978; 69:289.
- Pyke CM, van Heerden JA, Colby TV, et al. The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 1992; 215:132.
- Lundstedt C, Dawiskiba S. Serous and mucinous cystadenoma/cystadenocarcinoma of the pancreas. Abdom Imaging 2000; 25:201.
- Brugge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pancreas. N Engl J Med 2004; 351:1218.
- Lewandrowski K, Warshaw A, Compton C. Macrocystic serous cystadenoma of the pancreas: a morphologic variant differing from microcystic adenoma. Hum Pathol 1992; 23:871.
- Gouhiri M, Soyer P, Barbagelatta M, Rymer R. Macrocystic serous cystadenoma of the pancreas: CT and endosonographic features. Abdom Imaging 1999; 24:72.
- Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg 2000; 231:205.
- Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999; 23:410.
- Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol 2004; 2:1026.
- D'Angelica M, Brennan MF, Suriawinata AA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg 2004; 239:400.
- Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004; 239:788.
- Kloeppel G, Solcia E, Longnecker DS, et al. Histological typing of tumours of the exocrine pancreas. In: World Health Organization International Histological Classification of Tumours, Springer Verlag, New York 1996.
- Solcia EC, Kloppel G. Tumors of the pancreas, Fascicle 20. 3rd series ed, Armed Forces Institute of Pathology, Washington, DC 1997.
- Master SS, Savides TJ. Diagnosis of solid-pseudopapillary neoplasm of the pancreas by EUS-guided FNA. Gastrointest Endosc 2003; 57:965.
- Mergener K, Detweiler SE, Traverso LW. Solid pseudopapillary tumor of the pancreas: diagnosis by EUS-guided fine-needle aspiration. Endoscopy 2003; 35:1083.
- TYPES OF PANCREATIC CYSTS
- Inflammatory fluid collections
- NON-NEOPLASTIC PANCREATIC CYSTS
- True cysts
- Retention cysts
- Mucinous non-neoplastic cysts
- Lymphoepithelial cysts
- PANCREATIC CYSTIC NEOPLASMS
- Serous cystic tumors
- Mucinous cystic neoplasms
- Intraductal papillary mucinous neoplasms
- Solid pseudopapillary neoplasms
- Malignant potential
- CYSTIC DEGENERATION IN SOLID PANCREATIC TUMORS
- SUMMARY AND RECOMMENDATIONS