Diagnosis and Management of Cystic Lesions of the Pancreas

Table 2

Distinguishing features of pancreatic cystic lesions*.

Typical characteristics	IPMN	MCN	SCN	PSEUDO	SPN	LEC	cNET	cPDAC
Age group	Elderly	Middle	Middle-elderly	Any	Young	Elderly	Middle-Elderly	Elderly
Gender	>50% male	95% female	>50% female	>50% male	80%–90% female	80% male	50% each	>50% male
History	Asx; pain;± jaundice	Asx; Pain; nausea	Asx; VHL	Pancreatitis	Asx; pain; nausea	Asx	Asx; Fxnl; MEN	Asx; pain; ± jaundice
% of all cysts***	17%–40%	9%–28%	7%–36%	1%–19%	1%–13%	<2%	<8%	13%–16%
Location in pancreas	Head in 70%; multifocal	Body/Tail in 95%	Anywhere	Anywhere	Anywhere	Peripheral	Anywhere	Anywhere
Shape	Ovoid	Spheroid	Ovoid	Spheroid	Ovoid	Ovoid	Spheroid	Variable
Locularity	Any	Uni- or oligo-	Oligo- or multi-	Uni-	Oligo- or Multi-	Oligo-	Uni-	Any
Duct com-munication	Common	No	No	Common	No	No	No	Some
Calcification	No	No	Central sunburst	No	Some	No	Some	No
Cyst fluid appearance	Viscous, clear, muc.	Viscous, clear, muc.	Thin, clear, nonmuc.	Opaque, bloody/ necrotic debris	Opaque, bloody/ necrotic debris	Nonmuc., crystalline debris	Nonmuc.	Thin
High CEA/Mucin**	+	+	−	−	−	−	−	±
High Ca19-9	±	±	−	−	−	−	−	±
High amylase	+	−	−	+	−	−	−	±
Epithelium	Columnar, papillary	Columnar	Cuboidal	No epithelium	Poorly cohesive cells with nuclear grooves	Squamoid	Uniform	Gland-forming
Stroma	Fibrotic	Ovarian	Fibrotic	Fibrotic	Sometimes hyalinized	Lymphoid	Sometimes hyalinized	Fibrotic

Abbreviations: IPMN: intraductal papillary mucinous neoplasm; MCN: mucinous cystic neoplasm; SC: serous cystadenoma; PSEUDO: pancreatic pseudocyst; SPN: solid-pseudopapillary neoplasm; LEC: lymphoepithelial cyst; cNET: cystic neuroendocrine tumor; cPDAC: pancreatic ductal adenocarcinoma with cystic degeneration; VHL: von Hippel-Lindau disease; muc.: mucinous; Nonmuc: nonmucinous; Asx: asymptomatic; Fxnl: functional.
***Percentages references [8, 9, 22, 40].
**May be positive in cases of luminal contamination of endoscopic needle aspirate.
NB: These data are derived generalizations of the literature, with the understanding that there is significant overlap among cyst types and there are inherent sampling errors associated with various tests; diagnostic and treatment decisions should not rely solely on the information presented in this paper.
*Table modified from [7] by Cunningham et al. Intraductal papillary mucinous neoplasms are differentiated from other pancreatic cystic lesions. World J Gastrointest Surg 2010; 2(10): 331–336. An electronic worksheet version of this table is available at http://pathology.jhu.edu/pancreas/professionals/ipmn.php.