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? »
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Abdominal Pain - Learn about abdominal pain (pain in the stomach / abdomen) including causes, symptoms, how abdominal pain is diagnosed, and how abdominal pain is treated.
- MRI (Magnetic Resonance Imaging Scan) - Medical information on magnetic resonance imaging (MRI) used in detecting structural abnormalities of the body. Learn uses, risks, and how to prepare for an MRI scan
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