Cystic neoplasms of the pancreas

Abstract

As the use of cross-sectional imaging has become more frequent, there has been an increase in the diagnosis of cystic neoplasms and small non-functioning neuroendocrine neoplasms within the pancreas. Investigation and follow-up of cystic lesions of the pancreas requires a multi-modal approach, of which endoscopic ultrasound with biopsy is becoming an increasingly important component. The main premalignant cystic neoplasms of the pancreas are mucinous-type tumours, intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). Main-duct IPMN should be resected due to the high incidence of underlying malignancy; however, a selective approach to intervention for side-branch IPMN should be taken (dependent on the presence of symptoms, tumour markers and tumour characteristics). Pancreatic neuroendocrine neoplasms (PanNENs) can also present as cystic lesions. Biochemically confirmed functional PanNEN and non-secreting PanNENs larger than 2 cm in size should be evaluated for surgery.