Cystic Lesions of the Pancreas: Observe or Operate

Excerpt

A cystic lesion of the pancreas is a radiographic finding that has a broad histologic differential. This differential includes non-neoplastic pseudocysts, benign neoplastic cysts, pre-malignant cysts, and cystic lesions with invasive carcinoma [1]. Because of the increased use of high-quality cross-sectional imaging, an increasing number of patients are being identified with small asymptomatic cysts, and the management of these patients has become very controversial [2, 3]. This controversy has centered on the inability to determine the exact histopathologic diagnosis without resection. Because of this diagnostic uncertainty, many authors have recommended routine resection of all pancreatic cysts [4, 5]. It should be emphasized, however, that the ability to determine the histologic diagnosis of pancreatic cysts without resection continues to improve, and current imaging and endoscopic techniques can typically differentiate benign serous from pre-cancerous mucinous cysts of the pancreas. In addition, even within the mucinous sub-group, our ability to detect high-risk lesions is improving. …