Pancreatic cystic lesion
Pancreatic cystic lesion prevalence is 2.5% between 40 to 84 years old.
This guidance should be applied to incidentally detected pancreatic cysts ONLY IF the patient is both an adult (>18 years of age) and asymptomatic. If the patient has abdominal pain, the pain should not be attributable to the cyst.
This guidance does NOT apply to patient with potentially related sign or symptom (eg, jaundice, anorexia, weight loss, palpable mass, steatorrhea or abdominal pain potentially attributable to the cyst) or a relevant abnormal lab value (eg, elevated amylase).
Are there any worrisome features associated with the cystic lesion? (Appearance of mural nodule, wall thickening, dilation of MPD >= 7 mm, or extrahepatic biliary obstruction/jaundice.)
Yes.
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For every pancreatic cyst, please consider reporting the following six elements:
1. Cyst morphology, location.
2. Cyst size.
3. Possible communication with main pancreatic duct (MPD).
4. Presence of “worrisome features” and/or “high risk stigmata“.
5. Growth on follow-up examination.
6. Multiplicity.
Worrisome Features: Cyst >= 3 cm. Thickened/enhancing cyst wall. Nonenhancing mural nodule. MPD caliber >= 7 mm.
High Risk Stigmata: Obstructive jaundice/extrahepatic biliary obstruction with cyst in head of pancreas. Enhancing solid component within the cyst. MPD caliber >= 10 mm in absence of obstruction.
IPMN is further divided into BD-IPMN (branch duct form, 12%-47% malignancy rate), main duct form (38-68% malignancy rate) and combined form (both branch duct and main duct involved, 38-65% malignancy rate).
Solid pseudopapillary epithelial neoplasm is a rare tumor exclusively seen in young adult women.
Mucinous cystic neoplasm with ovarian stroma (MCN, formerly known as mucinous cystadenoma) is seen in middle age women 99% of time.
Serous cystadenoma is seen in old women 75% of time.