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.

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