Pancreatic cysts are very common and usually discovered incidentally in patients completely asymptomatic otherwise. Many of the cysts are discovered in patients who do some kind of abdominal imaging, usually CT or MRI for another reason. The pancreatic cysts are usually benign and have no malignant potential, but some of them may become malignant, so correct diagnosis is very critical.
Sometimes cysts are developed in patients who have a history of inflammation of the pancreas. These are called pseudocysts and are benign without malignant potential. Cysts may just grow in the pancreatic gland and grow to big sizes or may involve the main pancreatic duct or its branches. These kind of cysts may be benign but also may have malignant potential.
The diagnosis is usually made with endoscopic ultrasound or a non-invasive imaging technique such as MRI with or without MRCP. Also, CT with pancreatic protocol may be performed as an alternative. If endoscopic ultrasound is performed we have the ability to obtain fluid or tissue from the cyst for analysis and cytology. The content of the cysts may range from completely transparent and watery to dark coloured and viscous. Many times even visually inspecting the content of the cyst helps us determine its type.
If the cyst has worrisome features or it is associated with symptoms such as pain or jaundice, the patient is referred to surgery. However, sometimes a cyst will just need to be surveilled. This approach is for patients with neoplastic cysts which continue to have a malignant potential, given the fact that the risk of malignant transformation of cyst is relatively low. In these cases the risk of follow up is weighed against the risk of surgery. The surveillance protocol is determined by the type and size of the cyst and is usually recommended for patients who are potential surgical candidates or have a reasonable life expectancy.
