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 Topics | 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