Cystic Tumours of the Pancreas – a Rare and Diverse Type of Tumours


Objective: Increasing incidence of non-inflammatory cystic lesions of the pancreas challenges work-up algorithms, surgery and surveillance. We have reviewed our experience with these tumours in accordance with International Consensus Guidelines and evaluated the outcome. Patients and Methods: From 1999 to 2009, 34 cases referred to Haukeland University Hospital were operated upon; ten were serous (SCN), twenty-one IPMNs, one MCN, and two solid pseudopapillary neoplasms (SPPN). A thorough medical history was supplemented by CT, MRI, and US before each case were discussed in a MDT to decide on the best subsequent care. Results: All SCN and SPPN patients had benign histopathology, and no deaths were reported. Survival for malignant IPMN was, 2 years: 75%, and 5 years: 67%, where after no deaths were registered in the observation period. Presence of jaundice had the highest impact on survival (p = 0.0009), followed by weight loss (p = 0.005) and dilatation of the common bile duct (p = 0.04). In the IPMN group two had pancreatic juice leakage, and reoperation was performed in one. Conclusions: All SCN turned out benign which justify a high threshold for resection unless unacceptable symptoms dominate. For branch duct IPMNs resections of asymptomatic and smaller lesions (<3 cm) should be avoided but kept under surveillance, whereas symptomatic and lager lesions together with main duct IPMNs lodge a substantial malignant potential and should be resected. Symptomatic or large SPPNs can be, or turn, malignant which require resection.

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D. Hoem and A. Viste, "Cystic Tumours of the Pancreas – a Rare and Diverse Type of Tumours," Journal of Cancer Therapy, Vol. 3 No. 4, 2012, pp. 222-229. doi: 10.4236/jct.2012.34032.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] W. Kimura, H. Nagai, A. Kuroda, et al., “Analysis of Small Cystic Lesions of the Pancreas,” International Journal of Gastrointestinal Cancer, Vol. 18, No. 3, 1995, pp. 197-206.
[2] C. Fernandez-del Castillo, J. Targarona, S. P. Thayer, et al., “Incidental Pancreatic Cysts: Clinicopathologic Characteristics and Comparison with Symptomatic Patients,” Archives of Surgery, Vol. 138, No. 4, 2003, pp. 427-434. doi:10.1001/archsurg.138.4.427
[3] W. R. Brugge, G. Y. Lasuwers, D. Sahani, et al., “Cystic Neoplasms of the Pancreas,” The New England Journal of Medicine, Vol. 35, 2004, pp. 1218-1226. doi:10.1056/NEJMra031623
[4] J. A. Wargo, C. Fernandez-del-Castillo and A. L. Warshaw, “Management of Pancreatic Serous Cystadenomas,” Advances in Surgery, Vol. 43, No. 1, 2009, pp. 23-34. doi:10.1016/j.yasu.2009.03.001
[5] F. T. Bosman, F. Carneiro, R. H. Hruban and N. D. Theise, “WHO Classification of Tumours of the Digestive System,” WHO Press, Lyon, 2010, pp. 279-337.
[6] M. Tanaka, S. Chari, V. Adsay, C. Fernandez-del-Castillo, M. Falconi, M. Shimizu, et al., “International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas,” Pancreatology, Vol. 6, No. 1-2, 2006, pp. 17-32. doi:10.1159/000090023
[7] T. Furukawa, G. Kl?ppel, N. Volkan Adsay, J. Albores-Saavedra, N. Fukushima, A. Horii, R. H. Hruban, Y. Kato, D. S. Klimstra, D. S. Longnecker, J. Lüttges, G. J. Offerhaus, M. Shimizu, M. Sunamura, A. Suriawinata, K. Takaori and S. Yonezawa, “Classification of Types of Intraductal Papillary-Mucinous Neoplasm of the Pancreas: A Consensus Study,” Virchows Archiv, Vol. 447, No. 5, 2005, pp. 794-799. doi:10.1007/s00428-005-0039-7
[8] S. Reddy and C. L. Wolfgang, “Solid Psudopapillary Neoplasms of the Pancreas,” Advances in Surgery, Vol. 43, No. 1, 2009, pp. 269-282. doi:10.1016/j.yasu.2009.02.011
[9] J. M. Matos, R. Grützmann, N. P. Agaram, H. D. Saeger, H. R. Kumar, K. D. Lillemore, et al., “Solid Pseudopapillary Neoplasms of the Pancreas: A Multi-Institutional Study of 21 Patients,” Journal of Surgical Research, Vol. 157, No. 1, 2009, pp. 137-142. doi:10.1016/j.jss.2009.03.091
[10] Y. E. Chung, M. J. Kim, J. Y. Choi, J. S. Lim, H. S. Hong, Y. C. Kim, et al., “Differentiation of Benign and Malignant Solid Pseudopapillary Neoplasms of the Pancreas,” Journal of Computer Assisted Tomography, Vol. 33, 2009, pp. 689-694. doi:10.1097/RCT.0b013e31818f2a74
[11] E. C. Lai, S. H. Lau and W. Y. Lau, “Measures to Prevent Pancreatic Fistula after Pancreatoduodenectomy,” Archives of Surgery, Vol. 144, No. 11, 2009, pp. 1174-1180. doi:10.1001/archsurg.2009.193
[12] P. Bernard, J. Y. Scoazec, M. Joubert, X. Kahn, J. Le Borgne, F. Berger and C. Partensky, “Intraductal Papillary-Mucinous Tumors of the Pancreas: Predictive Criteria of Malignancy according to Pathological Examination of 53 Cases,” Archives of Surgery, Vol. 137, No. 11, 2002, pp. 1274-1278. doi:10.1001/archsurg.137.11.1274
[13] K. Yamao, K. Ohashi, T. Nakamura, T. Suzuki, Y. Shimizu, Y. Nakamura, Y. Horibe, A. Yanagisawa, A. Nakao, Y. Nimuara, Y. Naito and T. Hayakawa, “The Prognosis of Intraductal Papillary Mucinous Tumors of the Pancreas,” Hepatogastroenterology, Vol. 47, No. 34, 2000, pp. 1129-1134.
[14] B. Terris, P. Ponsot, F. Paye, P. Hammel, A. Sauvanet, G. Molas, P. Bernades, J. Belghiti, P. Ruszniewski and J. F. Fléjou, “Intraductal Papillary Mucinous Tumors of the Pancreas Confined to Secondary Ducts Show Less Aggressive Pathologic Features as Compared with Those Involving the Main Pancreatic Duct,” The American Journal of Surgical Pathology, Vol. 24, 2000, pp. 1372-1377. doi:10.1097/00000478-200010000-00006
[15] J. Sreenarasimhaiah, L. F. Lara, S. F. Jazrawi, C. C. Barnett, S. Tang, “A Comparative Analysis of Pancreas Cyst Fluid CEA and Histology with DNA Mutational Analysis in the Detection of Mucin Producing or Malignant Cysts,” Journal of Pancreas, Vol. 10, No. 2, 2009, pp. 163-168.
[16] A. Khalid, M. Zahid, S. D. Finkelstein, J. K. LeBlanc, N. Kaushik, N. Ahmad, et al., “Pancreatic Cyst Fluid DNA Analysis in Evaluating Pancreatic Cysts: A Report of the PANDA Study,” Gastrointestinal Endoscopy, Vol. 69, No. 6, 2009, pp. 1095-1102. doi:10.1016/j.gie.2008.07.033
[17] A. V. Maker, N. Katabi, L. X. Qin, et al., “Cyst Fluid Interleukin-1b (IL1b) Levels Predict the Risk of Carcinoma in Intraductal Papillary Mucinous Neoplasms of the Pancreas,” Clinical Cancer Research, Vol. 17, No. 6, 2011, pp. 1502-1508.
[18] A. V. Maker, L. S. Lee, C. P. Raut and T. E. Clancy and R. S. Swanson, “Cytology from Pancreatic Cysts Has Marginal Utility in Surgical Decision-Making,” Annals of Surgical Oncology, Vol. 15, No. 11, 2008, pp. 3187-3192. doi:10.1245/s10434-008-0110-0
[19] R. Salvia, C. Fernández-del Castillo, C. Bassi, S. P. Thayer, M. Falconi, W. Mantovani, P. Pederzoli and A. L. Warshaw, “Main-Duct Intraductal Papillary Micinous Neoplasms of the Pancreas: Clinical Predictors of Malignancy and Long Term Survival Following Resection,” Annals of Surgery, Vol. 239, No. 5, 2004, pp. 678-685. doi:10.1097/01.sla.0000124386.54496.15
[20] C. M. Schmidt, P. B. White, J. A. Waters, C. T. Yiannoutsos, O. W. Cummings, M Baker, T. J. Howard, N. J. Zyromski, A. Nakeeb, J. M. DeWitt, F. M. Akisik, S. Sherman, H. A. Pitt and K. D. Lillemoe, “Intraductal Papillary Mucinous Neoplasms: Predictors of Malignant and Invasive Pathology,” Annals of Surgery, Vol. 246, No. 4, 2007, pp. 644-651. doi:10.1097/SLA.0b013e318155a9e5
[21] A. Couvelard, A. Sauvanet, R. Kianmanesh, P. Hammel, N. Colnot, P. Lévy, P. Ruszniewski, P. Bedossa and J. Belghiti, “Frozen Sectioning of the Pancreatic Cut Surface during Resection of Intraductal Papillary Mucinous Neoplasms of the Pancreas Is Useful and Reliable: A Prospective Evaluation,” Annals of Surgery, Vol. 242, No. 6, 2005, pp. 774-778. doi:10.1097/01.sla.0000188459.99624.a2
[22] J. R. Rodriguez, R. Salvia, S. Crippa, A. L. Warshaw, C. Bassi, M. Falconi, S. P. Thayer, G. Y. Lauwers, P. Capelli, M. Mino-Kenudson, O. Razo, D. McGrath, P. Pederzoli, C. Fernández-Del Castillo, “Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection,” Gastroenterology, Vol. 133, No. 1, 2007, pp. 72-79. doi:10.1053/j.gastro.2007.05.010
[23] C. Bassi, C. Dervenis, G. Butturini, et al., “Postoperative Pancreatic Fistula: An International Study Group (ISGPF) Definition,” Surgery, Vol. 138, No.1, 2005, pp. 8-13. doi:10.1016/j.surg.2005.05.001
[24] O. Kollmar, M. R Moussavian, M. Bolli, et al., “Pancreatojejunal Leakage after Pancreas Head Resection: Anatomic and Surgeon-Related Factors,” Journal of Gastrointestinal Surgery, Vol. 11, No. 12, 2007, pp. 1699- 1703. doi:10.1007/s11605-007-0258-0
[25] W. B. Pratt, M. P. Callery and C. M. Vollmer Jr., “Risk Prediction for Development of Pancreatic Fistula Using the ISGPF Classification Scheme,” World Journal of Surgery, Vol. 32, No. 3, 2008, pp. 419-428. doi:10.1007/s00268-007-9388-5
[26] K. Kobayashi, Y. Sadakari, T. Ohtsuka, S. Takahata, M. Nakamura, K. Mizumoto and M. Taknaka, “Factors in Intraductal Papillary Mucinous Neoplasms of the Pancreas Predictive of Lymph Node Metastasis,” Pancreatology, Vol. 10, No. 6, 2011, pp. 720-725. doi:10.1159/000320709
[27] K. Nagai, R. Doi, A. Kida, K. Kami, Y. Kawaguchi, T. Ito, et al., “Intraductal Papillary Mucinous Neoplasms of the Pancreas: Clinicopathologic Characteristics and Long Term Follow-Up after Resection,” World Journal of Surgery, Vol. 32, No. 2, 2008, pp. 271-278. doi:10.1007/s00268-007-9281-2

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