If you are a clinician treating patients with pancreatic cysts, you may find that playing with the below teaching tool is a good way to familiarize yourself with the common presentations and manifestations of pancreatic cysts.

Pancreas Cyst Worksheet

(This tool is designed for desktop users. If you are experiencing trouble on a mobile device, please visit again on desktop.)

Select the applicable boxes. Multiple selections possible. Reset fields

Location

Locularity

Shape

Age

Gender

Duct Communication

CEA/Mucin*

Ca 19-9

History

Cyst Fluid

Amylase

Calcification

Typical Characteristics IPMN MCN SC PSEUDO ** SPN LEC cNET cPDAC
Age Group Elderly Middle Middle-Elderly Any Young Elderly Middle-Elderly Elderly
Gender 70% male 95% female >50% female >50% male 80%-90% female 80% male 50% each >50% male
History Asx; Pain; +/- Jaundice Asx; Pain; Nausea Asx; VHL Pancreatitis ** Asx; Pain; Nausea Asx Asx; Fxnl; MEN Asx; Pain; +/- Jaundice
Location in Pancreas Head in 70%;
Multi-focal
Body/Tail in 95% Anywhere Anywhere Anywhere Peripheral Anywhere Anywhere
Shape Ovoid Spherical Ovoid Spherical Ovoid Ovoid Spherical Variable
Locularity Any Uni or Oligo Oligo or Multi Uni Oligo or Multi Uni or Oligo Uni Any
Duct Com-munication Common No No Common No No No Some
Calcification No No Central sunburst No Some No Some No
Cyst Fluid Appearance Viscous, clear, muc Viscous, clear, muc Thin, clear, nonmuc Opaque, bloody/ Necrotic debris Opaque, bloody/ Necrotic debris Nonmuc, pasty, debris Nonmuc Thin
High CEA/Mucin* + + - - - - - +/-
High Ca 19-9 +/- +/- - + - - - +/-
Amylase + - - + - - - +/-

Abbreviations: IPMN, intraductal papillary mucinous neoplasm; MCN. Mucinous cystic neoplasm; SC, serous cystadenoma; PSEUDO, pancreatic pseudocyst; SPN, solid-pseudopapillary neoplasm; LE, lymphoepithelial cyst; cNET cystic neuroendocrine tumor; cPDAC, pancreatic ductal adenocarcinoma with cystic degeneration; VHL, von Hippel-Lindau disease; Muc, mucinous; Nonmuc, nonmucinous; Asx, asymptomatic; Fxnl, functional.

*May be positive in cases of luminal contamination of endoscopic needle aspirate

**NB: pancreatic pseudocyst is very unlikely in the absence of a history of pancreatitis

Disclaimer: This teaching tool is derived generalizations of the literature, with the understanding that there is significant overlap among cyst types and there are inherent sampling errors associated with various tests. This tool is meant only as a general teaching tool. It is not to be used for diagnostic and treatment decisions.

Key Questions to Ask

Key questions to ask when making a likely diagnosis of pancreatic cyst.

Key Question Likely Diagnoses to Consider
Demographics & History
Male? MCN unlikely
No history of pancreatitis? PSUDO unlikely
Young female? SPN
History of MEN? cNET
History VHL? SC
Imaging
Spheroid? PSEUDO or MCN
Central sunburst calcification? SC
Location in head? MCN unlikely
Cyst Fluid
No CEA/mucin? IPMN or MCN unlikely
High CEA, high amylase? IPMN
High CEA, low amylase? MCN
Low CEA, high amylase? PSUEDO
High amylase? IPMN or PSEUDO
Histology
Epithlelial lining? PSEUDO unlikely
Ovarian stroma? MCN

by Dr. Steven Cunningham