Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1128 Pancreatic Cysts

PANCREATIC CYSTS

ANSON W. LOWE, MD

history & physical

■Pancreatitis vs. non-pancreatitis associated cysts

■Pancreatitis associated cysts are treated as pseudocysts. (see section

on acute an chronic pancreatitis for further details)

■pseudocysts usually develop in the setting of chronic pancreatitis or

acute necrotizing pancreatitis

■Non-pancreatitis associated cysts may represent neoplastic lesions.

Symptoms and Signs

■Because of improved imaging techniques, pancreatic cysts are often

incidentally found.

■Abdominal or back pain

■Weight loss

■Early satiety

■Nausea and vomiting

tests

■no standard approach to pancreatic cysts has been established.

There is currently no definitive approach aside from surgical resec-

tion to determine whether a cyst represents a neoplastic lesion. Com-

monly used diagnostic approaches include:

➣endoscopic ultrasound (EUS) – may be the most sensitive and

can be used to obtain cyst fluid at the time of examination

■cytology of the cyst fluid is often of insufficient sensitivity

■analysis of the cyst fluid should be considered investigational and

may include:

➣viscosity

➣amylase

➣CEA

➣CA 19-9

➣CA 72-4

■high resolution spiral abdominal CT scan

■cystic features such as the thickness of the wall and septae may help

differentiate benign from neoplastic lesions.

■ERCP may reveal a communication of the cysts with the pancreatic

duct which occurs in 65% of pseudocysts and almost never with neo-

plastic cysts.