Pancreatic cysts

Question 1

what are pancreatic cysts?

Answer 1

collections of fluid that form within the pancreas

they are divided into true cysts (non inflammatory) and pseudocysts (inflammatory)

pseudocysts also lack and epithelial winning

Question 2

how are pancreatic cysts classified?

Answer 2

can be done by their

• secretions
• histology
• risk of malignancy

Question 3

true of false: generally, serous cysts are lower risk and mutinous cysts are higher risk

Answer 3

TRUE

Question 4

What are the clinical features of pancreatic cyst?

Answer 4

generally asymptomatic, found incidentally on imaging

symptomatic cysts, may present with

• abdo/back pain
• post obstructive jaundice
• vomiting

cysts can become infected and present wth systemic features

those that become malignant can present with systemic features of malignancy

• weight loss
• loss of appetite
• change in bowel habit

Question 5

what are your differential diagnoses?

Answer 5

pancreatic pseudocyst

typically form following pancreatitis

the inflammatory reaction produces a necrotic space in the pancreas that fills with pancreatic fluid

it lacks epithelial or endothelial cells around the collection = pseudocyst

asymptomatic but picked on on imaging

Question 6

what investigations can be done into pancreatic cysts?

Answer 6

baseline bloods

• FBC
• U&E
• LFTs
• a CA19-9 can be helpful to monitor progression

NICE suggests pancreatic protocol CT scan or MRI cholangiopancreatography

if needed, can further investigate through endoscopic US scan with fine needle aspiration for biopsy to determine high and low grade lesions.

Question 7

what are the high risk features of cysts on imaging?

Answer 7

• cyst diameter >3cm
• main pancreatic duct dilation greater than 10mm
• enhancing solid component
• non enhancing mural nodule

Question 8

what is the management for pancreatic cysts?

Answer 8

discuss with MDT

most are benign and can be left allow with surveillance only

resection in high risk cysts, followed up by an MRI every 2 years

low risk cysts, surveillance every 5 years

Question 9

what is the prognosis of pancreatic cysts?

Answer 9

• highly dependent on subtype of cyst and degree of invasion
• non malignant/non invasive will have good prognosis
• if invasive/malignant, survival of 60% at 5 years despite treatment