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Pancreatic Cysts (cont.)

Non-inflammatory cysts

  • Serous cyst adenomas: These cysts are mostly benign and commonly occur in middle-aged women. They usually are located in the body or tail of the pancreas. Typically they are small and cause no symptoms. Rarely they cause abdominal pain.
  • Mucinous cyst adenomas: Thirty percent of these cysts contain cancer, and those that do not contain cancer are considered precancerous. They also are more common in middle-aged women and are usually located in the body or tail of the pancreas.
  • Intraductal papillary mucinous neoplasm (IPMN): These cysts have a high likelihood of being or becoming cancerous. At the time of diagnosis, there is a 40%-50% chance of already being cancerous. These cysts are more common among middle-aged men and are more commonly located in the head of the pancreas. The cysts typically produce large amounts of mucous which can be seen draining out of the ampulla of Vater at the time of endoscopic retrograde cholangio-pancreatography (ERCP), a test that visualizes the ampulla of Vater and the pancreatic duct. These cysts can cause abdominal pain, jaundice and pancreatitis.
  • Solid pseudopapillary tumor of the pancreas: These are rare tumors found mainly in young Asian and black females. They may reach a large size, and can become malignant. Prognosis is excellent after complete surgical resection of these tumors.

How are pancreatic cysts diagnosed?

Since the majority of pancreatic cysts are small and produce no symptoms, they often are discovered incidentally when abdominal scans (ultrasound, CT scan, or MRI) are performed to investigate unrelated symptoms. Unfortunately, ultrasound, CT, and MRI scans cannot reliably distinguish benign cysts (cysts that usually need no treatment) from precancerous and cancerous cysts (cysts that usually require surgical removal).

Endoscopic ultrasound (EUS) is becoming increasingly useful in determining whether a pancreatic cyst is benign, precancerous, or cancerous. During EUS, an endoscope with a small ultrasound transducer on its tip is inserted through the mouth, esophagus, and stomach into the duodenum. From this location very close to the pancreas, liver, and gallbladder, accurate and detailed images can be obtained of the liver, pancreas and the gallbladder.

During EUS fluid from cysts and samples of tissue also can be obtained by passing special needles through the endoscope and into the cysts or tumors. The process of obtaining tissue or fluid with a thin needle is called fine needle aspiration (FNA).

The fluid obtained by FNA can be analyzed for cancerous cells (cytology), amylase content, and for tumor markers [tumor markers, such as CEA (carcinoembryonic antigen), are proteins produced in large quantities by tumor cells]. For example, pancreatic pseudocyst fluid will typically have high amylase levels but low CEA levels. A benign serous cyst adenoma will have low amylase and low CEA levels, whereas a precancerous or cancerous mucinous cyst adenoma will have low amylase levels but high CEA levels.

The cells obtained by fine needle aspiration can be examined under a microscope for cancer or precancerous cells.



Next: What is the treatment for pancreatic cysts? »

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