Cysts are fluid filled cavities in the body. Fluid is secreted by the lining of the cyst (epithelial layer) and the fluid accumulates within the cavity forming a cyst.
Cysts can form virtually within any body cavity and organ – liver, kidney, pancreas, abdomen, etc
With an increasing use of ultrasound and CT scan to understand patient symptoms and disease conditions, the detection of unrelated lesions and conditions (incidentalomas) – has become frequent.
In the same context pancreatic cysts are being detected on imaging with increasing frequency and its estimated that 0.3-20% of all patients undergoing scanning for some reason or another will have a cyst discovered within the pancreas.
Symptoms
- Asymptomatic – no symptoms : Incidental discovery. Most patients with pancreas cysts are asymptomatic and these cysts are discovered incidentally on imaging.
- Abdominal pain – vague and non specific abdominal pain may be present
- Nausea / vommiting or simply symptoms that are interpreted as “acidity”
- Jaundice – sometimes large cysts can cause jaundice by blockage of the bile ducts and pressure on them
Diagnosis
- CT scan : mandatory for diagnosis
- MRCP / MRI pancreas: further helps in defining the cyst and predicting its nature
- Endoscopy : ERCP / EUS : endoscopic ultrasound may be required and sampling of the cyst fluid and its contents / biopsy may be required to define treatment
Treatment
Treatment of the cyst depends on its nature and its potential to turn cancerous.
While most pancreatic cysts are benign there are specific type of cysts which carry a risk of harbouring a cancer within them or turning cancerous in the long term.
These specifically include the mutinous cysts- Mucinous Cystic neoplasms (MCN) and Intra ductal Papillary Mucinous Cysts (IMPN).
Hence all cysts within the pancreas should be very carefully evaluated and a defined management plan should be made depending on the nature of cyst.
While some cysts – Serous Cyst adenoma and selected Pseudocysts along with some IPMN can be kept under surveillance and don’t need treatment, surgery will be required for other types of cysts.
Surgery would involve removal of part of the pancreas carrying the cyst – pancreatic resection – open or laparoscopic.
Pseudocysts are non – neoplastic cysts that arise in the background of pancreatitis. Pesudocysts may be treated radiologically, endoscopically or even surgically.