Internal Medicine

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

Pancreatic Cysts 1129

Blood Tests

■elevated serum amylase suggests a pseudocyst secondary to pancre-

atitis

■CA19-9 and CEA may be elevated. Sensitivity is insufficient to be

used for screening purposes.

differential diagnosis

■Truly benign pancreatic cysts are rare. Most often, the goal is to differ-

entiate mucinous cystic tumors from serous cystadenomas. Differ-

entiation between different cyst types is often difficult to distinguish

from each other prior to resection.

■The most common lesions are mucinous cystic tumors and serous

cystadenomas

➣mucinous cystadenoma

➣mucinous cystadenocarcinoma

➣serous cystadenoma – malignant transformation is rare and thus

can be treated as a benign lesion

■Less common cystic lesions include

➣papillary cystic tumor

➣cystic neuroendocrine tumor

➣adenocarcinoma of the pancreas with cystic degeneration

➣acinar cystadenocarcinoma

➣cystic teratoma

➣lymphangioma

➣hemangioma

management

■Because current diagnostic modalities are often quite poor in deter-

mining whether a cystic lesion is malignant, evaluation and surgery

should be carried out in a facility experienced in the medical and

surgical management of pancreatic disease

■The only definitive approach in determining the identity of a cystic

lesion is surgical resection. Surgical outcomes of pancreatic resec-

tions are much better in institutions where the volume is high and

the necessary expertise is present.

specific therapy

n/a

follow-up

■dictated by the approach chosen