Pancreatic cystic Tumors

Cystic tumors of the pancreas are less frequent than solid lesions and are often detected incidentally, as many of these lesions are small and asymptomatic. However, they may be associated with pancreatitis and  have malignant potential. With advancements in diagnostic imaging, cystic lesions of the pancreas are being detected with increasing frequency. Many lesions can cause a pancreatic cyst, most being non-neoplastic while approximately 10% are cystic tumors, ranging from benign to highly malignant tumors. Even small cystic lesions of the pancreas appear to have the potential to progress to malignancy , and  need follow-up with repeat imaging and tumor marker.
A presumptive diagnosis of pseudocyst based on imaging appearance alone can cause a diagnostic error, and neoplastic cysts of the pancreas are particularly susceptible to this misdiagnosis, which can result in inappropriate treatment. Cystic tumors of the pancreas are formed by serous or mucinous structures showing all stages of cellular differentiation

Cystic pancreatic tumors can be subdivided into peripheral (serous cystadenomas, mucinous cystic tumors, solid and papillary epithelial neoplasms, cystic islet cell tumors), On the basis of imaging criteria alone, it can be very difficult to differentiate non-tumoral cystic lesions from neoplastic ones. The management of these patients are complex, and it is important to correlate imaging findings with knowledge of the patient’s symptoms and of the natural history and predictors of malignancy in pancreatic cysts.

Cystic tumours of pancreas needs evaluation to differentiate from its counter part pseudocyst first. If true cyst then to differentiate benign from malignant cystic lesion.(cancer). Imaging characteristics, tumour marker, per operative findings, cytology of cyst fluid, Frozen section of the cyst wall are the guideline for decision making about the nature of the lesion.  Malignant  (cancer) lesion needs adequate resection of the affected part of the pancreas. Benign lesion can be treated by internal drainage to bowel. Precaution to be taken that a cancerous lesion should never be left in the pancreas or drained to bowel

Solid Pseudopapillary tumor:
Solid pseudopapillary tumor (SPT) is the least frequent cystic tumor of the pancreas whose origin is still uncertain. It has a low malignant potential and a favorable prognosis. It may affect any age, but most often affects young women. Clinically it is fairly nonspecific, with abdominal pain as the main symptom, sometimes together with a palpable mass. The low malignant potential of the lesion is demonstrated by its large size at the time of the diagnosis . The tumor appears as a round, well-encapsulated mass . The content of the lesion is solid with a variable amount of necrosis or hemorrhage, responsible for its frequent cystic appearance. . After contrast agent administration the solid component of the tumor appears well vascularized ,cysts appear as hypodense areas.
This tumor should be treated by adequate pancreatic resection, which can offer cure in most circumstances.

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