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Cystic Tumours of Pancreas
What is the epidemiology of pancreatic cystic neoplasm?
Pancreatic cystic neoplasms are being increasingly identified with high-quality abdominal imaging and comprise at least 15% of all pancreatic cystic masses
What are the common types of cystic pancreatic neoplasm?
The three most common primary pancreatic cystic neoplasms are;
Serous cystic neoplasm | Mucinous cystic neoplasm | Intraductal papillary mucinous neoplasm (IPMN) |
---|---|---|
Predominantly affect women | Women>men | Men>women |
30% of primary cystic neoplasms | 40% | 30% |
Mostly found in the head of pancreas | Mostly in the body and tail | Can arise from the main duct or branch duct or both |
Well demarcated spongy, honeycomb mass with small cysts | Larger often solitary cyst to begin with and may have a septum or septae contained within the cyst. Does not communicate with the pancreatic duct | Characterised by intraductal proliferation of neoplastic mucinous cells forming papillae & excess mucous secretion. These changes lead to dilatation of the main pancreatic duct or branch duct. |
Fluid analysis- very low CEA and low amylase | High CEA (because CEA is being secreted by the columnar and the mucinous epithelium) and low amylase. Cytology will be positive, if malignant transformation | |
Relatively benign lesion (think of it like hyperplastic polyp of colon) | Benign lesion (think of it like adenomatous polyp of colon) but can turn into malignancy. | Greatly increased risk of colorectal cancer and other extrapancreatic cancers in patients with IPMN. |
May cause local effects, but no systemic problem | Local effects only. Malignant transformation can occur. All malignant cystic malignancies come from a mucinous lesion. |
What are the clinical features of these cystic neoplasms?
How do you diagnose cystic neoplasms of pancreas?
These values have not been firmly established. However a CEA of < 5- very high likelihood of it being serous and a CEA >200- very high suspicion of mucinous
Discuss the management options?
Ref
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