Most pancreatic cysts detected through CT or MRI imaging are benign pancreatic pseudocysts. These are not neoplasms or “new growths,” but represent fluid that leaks out of the pancreas in response to an episode of inflammation ( called pancreatitis) or injury to the pancreas. Pseudocysts are unlikely to arise in people who have never had a documented severe attack of acute pancreatitis or another injury to the pancreas. Sometimes acute pancreatitis itself can be caused by one of the other types of cystic neoplasms. This is why all patients with pancreatic cysts would benefit from a multi-disciplinary expert review of their case by the team at the Pancreatic Cyst Center.
Serous Cystadenoma (SCA)
SCA are true cysts, but have little chance of either being or becoming cancerous. Further testing with biopsy and endoscopic ultrasound may be needed to determine if a cystic lesion is an SCA. Follow-up CT or MRI imaging is necessary to monitor serous cystadenomas for possible growth. While nearly all SCAs are benign, these cysts may cause symptoms such as pain and jaundice as they grow within the pancreas, requiring treatment.
Mucinous Cystic Neoplasm (MCN)
MCNs are mucin-producing, precancerous growths that occur mostly in young women. These types of tumors are often confused with pancreatic psudocysts. Follow-up imaging and endoscopic ultrasound with fluid analysis can help determine the type of cyst. Nodules or growths on the walls of these cysts can sometimes make them more suspicious for cancer. This type of cyst usually arises in the body and tail of the pancreas, which makes it amenable to minimally invasive surgical removal. At the very least, these types of lesions need to be evaluated and followed as per the International Guidelines.
Intraductal Papillary Mucinous Neoplasm (IPMN)
IPMNs are the most common type of precancerous cysts. IPMNs produce large amounts of mucin (a thick fluid) in their lining and fluid. IPMNs need to be evaluated and monitored to help ensure that they are stable and don’t become cancerous. There are specific findings on CT and MRI imaging that have been determined to help guide treatment. The purpose of the Pancreatic Cyst Clinic is to coordinate this treatment and follow-up. It’s important to determine whether the IPMN arises from the main pancreatic duct or from a side branch of the duct, and this often requires further testing with endoscopic ultrasound. Needle biopsy and fluid analysis can also be done during endoscopic ultrasound.