Cystic
(fluid filled) tumors of pancreas. How to deal??
Cystic
tumors of pancreas has become well known entities in last decade with incidence
of 2.6 per 100 individuals.
Type
of cystic tumors:
Ø
Pseudocysts (complication of pancreatitis or
trauma)
Ø
Serous cystadenoma
Ø
Mucinous cystadenoma
Ø
Intra ductal papillary mucinous neoplasms
(IMPNs)
Ø
Cystic lesions with invasive cancers.
Pseudocysts will be covered in next blog as they are very
common and required details explainations.
Ø
Serous cystadenomas:
o
Mostly benign tumors chances of malignancy is
less than 1%
o
Large size (> 10cm)
o
Classic honeycomb appearance is seen some times
with calcified central scar.
o
Because of fibrous nature on CT scan solid
material is also seen
o
Most symptoms are due to large size and compression
to other organs like pain, vomiting, jaundice.
o
Young patient
with large tumour should be offered surgery other patients should be kept on
regular followup.
Ø
Mucinous cystadenomas:
o
Mucin producing cystic tumors
o
Ovary like structure
o
Mostly in body and tail of pancreas
o
Can be from small size (2cm to very large 25 cm)
o
Mostly in female
o
Generally unilocular (single cavity)
o
CT scan may show egg shell appearance
o
Risk of being malignant (cancerous)
o
Treatment:
should be surgically removed.
Ø
Intraductal Papillary Mucinous neoplasms
o
Equally seen in men and women
o
Between 60 to 70 years of age
o
Risk of developing in to cancer present
o
May involve main pancreatic duct or branch
pancreatic duct
o
Presence of a discrete mass or solid component
should be concerning of malignancy
o
Branch duct IMPN is difficult to diagnose
o
Cancer is found in 20 to 40% of specimen
o
Surgically
removed if Entire pancreatic duct involvement, solid component , size greater
than 3 cm, presence of septation
Diagnosis:
Diagnosis is mostly done by CT
scan and MRCP/MRI. Sometimes endoscopic ultrasound helps. Cyst fluid analysis
also helps in diagnoses.
Treatment flow Chart:
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