TITLE:
Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management
AUTHORS:
Abd Elrafea Elkak
KEYWORDS:
Pancreatic Cystic Tumours, IPMN, Laparoscopic Pancreatic Surgery
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.10,
September
28,
2016
ABSTRACT: Background: Cystic tumours of the pancreas are
relatively uncommon tumours but there is an increasing awareness of their
importance. Modern advances in imaging had resulted in a more prompt diagnosis
of these tumours. The understanding of the pathology, clinical features,
diagnosis and management of these tumours is continuously evolving. Data Sources: Systematic literature review. A PubMed
database research was performed. Relevant articles published in
English were identified and scrutinized. Duplications of information and
persistently unsolved uncertainties were excluded. Results: Cystic tumours of the pancreas should be
differentiated from pancreatic pseudocysts. Cystic tumours could be classified
into: cystic serous neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal
papillary neoplasms (IPMN), solid pseudopapillary neoplasms (SPPN) and the
rarer tumours cystic pancreatic endocrine neoplasms (PEN). Except for SCN, all these
tumours should be regarded, at least, as potentially malignant but they may be
frankly malignant. The age of the patient and site of the lesion may be helpful
in the diagnosis. In particular, MCN is always encountered in females in their
middle age and often in the body and tail of the pancreas. Many of these
tumours are diagnosed incidentally. Pancreatitis and hyperamylasaemia should be
interpretted with caution as IPMN may present as pancreatitis. CT is the
primary diagnostic tool although MRI, EUS, PET, abdominal ultrasound and ERCP
have all been utilised. Biochemical markers are of limited value in the
diagnosis. Conclusions: Management
decision depends primarily on the understanding of pathology and on how
confident the preoperative diagnosis is. SCN may be observed. Partial pancreatectomy is the usual operation
performed for most other tumours according to the location of the lesion which
means that distal pancreatectomy is usually the operation performed for MCN.
Total pancreatectomy for IPMN, enucleation and central pancreatectomy have all
been described in the literature. Laparoscopy is more suitable for benign or
low grade malignant tumours in the context of distal pancreatectomy. Spleen
should be preserved unless splenectomy is indicated and splenic vessels should
be preserved wherever possible when preserving the spleen.