II. Epidemiology

  1. Incidental finding on advanced abdominal imaging in >2% of patients

III. Differential Diagnosis

  1. Pancreatic Cysts with malignant potential
    1. Mucinous Pancreatic Cysts
    2. Intraductal papillary mucinous Pancreatic Cysts
    3. Solid pseudopapillary pancreatic neoplasms
  2. Pancreatic Cysts without malignant potential
    1. Serous Pancreatic Cysts
      1. Malignancy is rare
      2. Surgical resection is only indicated if symptomatic or continued growth
    2. Pseudocysts
      1. Cysts lack an epithelial lining and typically occur after Pancreatitis
    3. Non-neoplastic Pancreatic Cysts (rare)
      1. Includes true cysts, retention cysts, lymphoepithelial cysts, mucinous non-neoplastic cysts

IV. Imaging

  1. Pitfalls
    1. Distinguishing Pancreatic Cysts with malignant potential on imaging is challenging
  2. MRI Abdomen
    1. Best imaging to characterize Pancreatic Cysts
  3. Suspicious findings
    1. Pancreatic Cyst >3 cm
      1. Associated with Pancreatic Cancer in 15% of cases
      2. Contrast with <5% malignancy rate in Pancreatic Cysts <3 cm
    2. Mural Nodules
    3. Lymphadenopathy
    4. Involvement of bile duct or pancreatic duct

V. Management

  1. Surgery indications
    1. Pancreatic Cysts >3 cm with suspicious findings (see above)
  2. Endoscopic Ultrasound with cyst aspiration indications
    1. Smaller cysts considered for possible resection
    2. Biochemical marker analysis to risk stratify cyst malignant potential
  3. Monitoring with serial imaging
    1. Pancreatic Cysts 1-3 cm not requiring surgical management or aspiration

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