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Cystic lesions of the pancreas (differential)

Changed by Yahya Baba, 13 Mar 2024

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Disclosures - updated 8 Apr 2023: Nothing to disclose

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The differential for cystic lesions of the pancreas includes:

unilocular
- pancreatic pseudocyst
- intraductal papillary mucinous neoplasm (IPMN)
- serous cystadenoma uncommonly uni/macrolocular
- simple pancreatic cyst
- cystic neuroendocrine tumour of the pancreas
diffuse pancreatic cysts
- pancreatic cysts occur in association with
  - von Hippel Lindau syndrome
  - autosomal dominant polycystic kidney disease (ADPKD)
  - isolated polycystic disease of the pancreas (IPDP)
  - ~~cystic fibrosis (~~pancreatic cystosis) - in cystic fibrosis
macrocystic: multilocular
- mucinous cystic neoplasm of the pancreas: usually body and tail
- intraductal papillary mucinous neoplasm (IPMN)
- serous cystadenoma uncommonly uni/macrolocular
- acinar cell cystadenocarcinoma
- hydatid cyst ¹²
microcystic
- serous cystadenoma: usually head; 30% have a central scar
cystic with a solid component
- walled-off pancreatic necrosis
- macrocystic tumours can also have a solid component
- solid pseudopapillary tumour of the pancreas
- primary ductal pancreatic tumour with cystic degeneration
- cystic degeneration of islet cell tumours (neuroendocrine tumours)
  - insulinoma
  - glucagonoma
cystic teratoma
metastases to pancreas

Retroperitoneal lesions (extrinsic to the pancreas) can mimic pancreatic cystic lesions, when close to the gland. Examples include:

cystic lymphadenopathy (e.g. necrotic)
duodenal diverticulum

Practical points

the American College of Radiology (ACR) published guidelines on managing incidental cystic pancreatic lesions in 2017¹¹
recent (c.2022) evidence reports that the incidence of pancreatic cancer in asymptomatic patients with cysts <2 cm is similar to background rates ¹⁴

~~-<li><p>cystic fibrosis (<a href="/articles/pancreatic-cystosis-1" title="Pancreatic Cystosis">pancreatic cystosis</a>)</p></li>~~
+<li><p><a href="/articles/pancreatic-cystosis-1" title="Pancreatic Cystosis">pancreatic cystosis</a> - in cystic fibrosis </p></li>

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Cystic lesions of the pancreas (differential)

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