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Received: 2012-10-17

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Journal of Zhejiang University SCIENCE B 2013 Vol.14 No.3 P.185-194


Pancreatic cystic neoplasms: a review of preoperative diagnosis and management

Author(s):  Xue-li Bai, Qi Zhang, Noman Masood, Waqas Masood, Yun Zhang, Ting-bo Liang

Affiliation(s):  Department of Hepatobiliary-Pancreatic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China

Corresponding email(s):   liangtingbo@zju.edu.cn

Key Words:  Pancreatic cystic neoplasms, Serous cystic neoplasms, Intraductal papillary mucinous neoplasms, Mucinous cystic neoplasms, Diagnosis

Xue-li Bai, Qi Zhang, Noman Masood, Waqas Masood, Yun Zhang, Ting-bo Liang. Pancreatic cystic neoplasms: a review of preoperative diagnosis and management[J]. Journal of Zhejiang University Science B, 2013, 14(3): 185-194.

@article{title="Pancreatic cystic neoplasms: a review of preoperative diagnosis and management",
author="Xue-li Bai, Qi Zhang, Noman Masood, Waqas Masood, Yun Zhang, Ting-bo Liang",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Pancreatic cystic neoplasms: a review of preoperative diagnosis and management
%A Xue-li Bai
%A Qi Zhang
%A Noman Masood
%A Waqas Masood
%A Yun Zhang
%A Ting-bo Liang
%J Journal of Zhejiang University SCIENCE B
%V 14
%N 3
%P 185-194
%@ 1673-1581
%D 2013
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1200283

T1 - Pancreatic cystic neoplasms: a review of preoperative diagnosis and management
A1 - Xue-li Bai
A1 - Qi Zhang
A1 - Noman Masood
A1 - Waqas Masood
A1 - Yun Zhang
A1 - Ting-bo Liang
J0 - Journal of Zhejiang University Science B
VL - 14
IS - 3
SP - 185
EP - 194
%@ 1673-1581
Y1 - 2013
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1200283

pancreatic cystic neoplasms (PCNs) are a diverse group of neoplasms in the pancreas, and are more increasingly encountered with widespread abdominal screening and improved imaging techniques. The most common types of PCNs are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas, which may lead to overtreatment or delayed treatment. The current review provides recent developments in the understanding of the three most common types of PCNs, the latest modalities used in preoperative diagnosis and differential diagnosis, as well as the most up to date management. Suggestions for diagnosis and differential diagnosis of SCNs, MCNs, and IPMNs are also provided for young surgeons. Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Abe, H., Kubota, K., Mori, M., Miki, K., Minagawa, M., Noie, T., Kimura, W., Makuuchi, M., 1998. Serous cystadenoma of the pancreas with invasive growth: benign or malignant? Am. J. Gastroenterol., 93(10):1963-1966.

[2]Adsay, N.V., 2002. Intraductal papillary mucinous neoplasms of the pancreas: pathology and molecular genetics. J. Gastrointest. Surg., 6(5):656-659.

[3]Adsay, N.V., Longnecker, D.S., Klimstra, D.S., 2000. Pancreatic tumors with cystic dilatation of the ducts: intraductal papillary mucinous neoplasms and intraductal oncocytic papillary neoplasms. Semin. Diagn. Pathol., 17(1):16-30.

[4]Adsay, N.V., Fukushima, N., Furukawa, T., Hruban, R.H., Klimstra, J.D.S., 2010. Intraductal Neoplasms of the Pancreas. In: Bosman, F.T., Carneiro, F., Hruban, R.H., Theise, N.D. (Eds.), World Health Organization Classification of Tumours of the Digestive System, 4th Ed. IARC, Lyon, p.304-313.

[5]Badea, R., Seicean, A., Diaconu, B., Stan-Iuga, R., Sparchez, Z., Tantau, M., Socaciu, M., 2009. Contrast-enhanced ultrasound of the pancreas—a method beyond its potential or a new diagnostic standard? J. Gastrointestin. Liver Dis., 18(2):237-242.

[6]Brugge, W.R., Lauwers, G.Y., Sahani, D., Fernandez-del Castillo, C., Warshaw, A.L., 2004a. Cystic neoplasms of the pancreas. N. Engl. J. Med., 351(12):1218-1226.

[7]Brugge, W.R., Lewandrowski, K., Lee-Lewandrowski, E., Centeno, B.A., Szydlo, T., Regan, S., Fernandez-del Castillo, C., Warshaw, A.L., 2004b. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology, 126(5):1330-1336.

[8]Buck, J.L., Hayes, W.S., 1990. Microcystic adenoma of the pancreas. Radiographics, 10(2):313-322.

[9]Campbell, F., Azadeh, B., 2008. Cystic neoplasms of the exocrine pancreas. Histopathology, 52(5):539-551.

[10]Chari, S.T., Yadav, D., Smyrk, T.C., DiMagno, E.P., Miller, L.J., Raimondo, M., Clain, J.E., Norton, I.A., Pearson, R.K., Petersen, B.T., et al., 2002. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology, 123(5):1500-1507.

[11]Cohen-Scali, F., Vilgrain, V., Brancatelli, G., Hammel, P., Vullierme, M.P., Sauvanet, A., Menu, Y., 2003. Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations. Radiology, 228(3):727-733.

[12]D′Onofrio, M., Gallotti, A., Principe, F., Mucelli, R.P., 2010. Contrast-enhanced ultrasound of the pancreas. World J. Radiol., 2(3):97-102.

[13]Eriguchi, N., Aoyagi, S., Nakayama, T., Hara, M., Miyazaki, T., Kutami, R., Jimi, A., 1998. Serous cystadenocarcinoma of the pancreas with liver metastases. J. Hepatobil. Pancreat. Surg., 5(4):467-470.

[14]Furukawa, T., Kloppel, G., Volkan Adsay, N., Albores-Saavedra, J., Fukushima, N., Horii, A., Hruban, R.H., Kato, Y., Klimstra, D.S., Longnecker, D.S., et al., 2005. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch., 447(5):794-799.

[15]Furukawa, T., Hatori, T., Fujita, I., Yamamoto, M., Kobayashi, M., Ohike, N., Morohoshi, T., Egawa, S., Unno, M., Takao, S., et al., 2011. Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut, 60(4):509-516.

[16]Gan, S.I., Thompson, C.C., Lauwers, G.Y., Bounds, B.C., Brugge, W.R., 2005. Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest. Endosc., 61(6):746-752.

[17]Garcea, G., Ong, S.L., Rajesh, A., Neal, C.P., Pollard, C.A., Berry, D.P., Dennison, A.R., 2008. Cystic lesions of the pancreas: a diagnostic and management dilemma. Pancreatology, 8(3):236-251.

[18]Goh, B.K., Tan, Y.M., Kumarasinghe, M.P., Ooi, L.L., 2005. Mucinous cystic tumor of the pancreas with ovarian-like mesenchymal stroma in a male patient. Dig. Dis. Sci., 50(11):2170-2177.

[19]Goh, B.K., Tan, Y.M., Chung, Y.F., Chow, P.K., Cheow, P.C., Wong, W.K., Ooi, L.L., 2006. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J. Surg., 30(12):2236-2245.

[20]Grogan, J.R., Saeian, K., Taylor, A.J., Quiroz, F., Demeure, M.J., Komorowski, R.A., 2001. Making sense of mucin-producing pancreatic tumors. Am. J. Roentgenol., 176(4):921-929.

[21]Iwamuro, M., Kawamoto, H., Shiraha, H., Nose, H., Yamamot, K., 2012. Pancreatic involvement in 11 cases of von Hippel-Lindau disease. Hepatogastroenterology, 59(114):589-591.

[22]Kauhanen, S.P., Komar, G., Seppänen, M.P., Dean, K.I., Minn, H.R., Kajander, S.A., Rinta-Kiikka, I., Alanen, K., Borra, R.J., Puolakkainen, P.A., et al., 2009. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann. Surg., 250(6):957-963.

[23]Kawamoto, S., Horton, K.M., Lawler, L.P., Hruban, R.H., Fishman, E.K., 2005. Intraductal papillary mucinous neoplasm of the pancreas: can benign lesions be differentiated from malignant lesions with multidetector CT? Radiographics, 25(6):1451-1470.

[24]Khalid, A., Brugge, W., 2007. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am. J. Gastroenterol., 102(10):2339-2349.

[25]Khurana, B., Mortele, K.J., Glickman, J., Silverman, S.G., Ros, P.R., 2003. Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation. Am. J. Roentgenol., 181(1):119-123.

[26]Kimura, W., Moriya, T., Hanada, K., Abe, H., Yanagisawa, A., Fukushima, N., Ohike, N., Shimizu, M., Hatori, T., Fujita, N., et al., 2012. Multicenter study of SCN of the Japan pancreas society: a multi-institutional study of 172 patients. Pancreas, 41(3):380-387.

[27]Kubo, H., Chijiiwa, Y., Akahoshi, K., Hamada, S., Harada, N., Sumii, T., Takashima, M., Nawata, H., 2001. Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography. Am. J. Gastroenterol., 96(5):1429-1434.

[28]Levy, M.J., 2009. Pancreatic cysts. Gastrointest. Endosc., 69(Suppl. 2):110-116.

[29]Lewandrowski, K.B., Southern, J.F., Pins, M.R., Compton, C.C., Warshaw, A.L., 1993. Cyst fluid analysis in the differential diagnosis of pancreatic cysts: a comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma. Ann. Surg., 217(1):41-47.

[30]Lim, J.H., Lee, G., Oh, Y.L., 2001. Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics, 21(2):323-337.

[31]Longnecker, D.S., Adler, G., 2000. Intraductal Papillary-Mucinous Neoplasms. In: Hamilton, S.R., Aaltonen, L.A. (Eds.), Pathology and Genetics of Tumours of the Digestive System. World Health Organization Classification of Tumours. IARC, Lyon, p.237-240.

[32]Lonser, R.R., Glenn, G.M., Walther, M., Chew, E.Y., Libutti, S.K., Linehan, W.M., Oldfield, E.H., 2003. von Hippel-Lindau disease. Lancet, 361(9374):2059-2067.

[33]Maire, F., Hammel, P., Terris, B., Olschwang, S., O′Toole, D., Sauvanet, A., Palazzo, L., Ponsot, P., Laplane, B., Levy, P., et al., 2002. Intraductal papillary and mucinous pancreatic tumour: a new extracolonic tumour in familial adenomatous polyposis. Gut, 51(3):446-449.

[34]Mansour, J.C., Schwartz, L., Pandit-Taskar, N., D′Angelica, M., Fong, Y., Larson, S.M., Brennan, M.F., Allen, P.J., 2006. The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas. J. Gastrointest. Surg., 10(10):1354-1360.

[35]Megibow, A.J., 2008. Pancreatic Neoplams. In: Gore, R.M., Levine, M.S. (Eds.), Textbook of Gastrointestinal Radiology, 3rd Ed. Elsevier Saunders, Philadelphia, p.1915-1931.

[36]Mohr, V.H., Vortmeyer, A.O., Zhuang, Z., Libutti, S.K., Walther, M.M., Choyke, P.L., Zbar, B., Linehan, W.M., Lubensky, I.A., 2000. Histopathology and molecular genetics of multiple cysts and microcystic (serous) adenomas of the pancreas in von Hippel-Lindau patients. Am. J. Pathol., 157(5):1615-1621.

[37]Nakamoto, Y., Higashi, T., Sakahara, H., Tamaki, N., Kogire, M., Doi, R., Hosotani, R., Imamura, M., Konishi, J., 2000. Delayed (18)F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer, 89(12):2547-2554.

[38]Oh, H.C., Seo, D.W., Song, T.J., Moon, S.H., Park, D.H., Lee, S.S., Lee, S.K., Kim, M.H., Kim, J., 2011. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology, 140(1):172-179.

[39]Ohhashi, K., Murakami, Y., Maruyama, M., 1982. Four cases of mucin-producing cancer of the pancreas on specific findings of the papilla of Vater. Prog. Dig. Endosc., 20:348-351.

[40]Pakzad, F., Groves, A.M., Ell, P.J., 2006. The role of positron emission tomography in the management of pancreatic cancer. Semin. Nucl. Med., 36(3):248-256.

[41]Penman, I.D., Lennon, A.M., 2011. EUS in the Evaluation of Pancreatic Cysts. In: Hawes, R.H., Fockens, P., Varadarajulu, S. (Eds.), Endosonography, 2nd Ed. Elsevier Saunders, Philadelphia, p.166-177.

[42]Recaldini, C., Carrafiello, G., Bertolotti, E., Angeretti, M.G., Fugazzola, C., 2008. Contrast-enhanced ultrasonograpic findings in pancreatic tumors. Int. J. Med. Sci., 5(4):203-208.

[43]Reddy, R.P., Smyrk, T.C., Zapiach, M., Levy, M.J., Pearson, R.K., Clain, J.E., Farnell, M.B., Sarr, M.G., Chari, S.T., 2004. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin. Gastroenterol. Hepatol., 2(11):1026-1031.

[44]Roggin, K.K., Chennat, J., Oto, A., Noffsinger, A., Briggs, A., Matthews, J.B., 2010. Pancreatic cystic neoplasm. Curr. Probl. Surg., 47(6):459-510.

[45]Sakorafas, G.H., Smyrniotis, V., Reid-Lombardo, K.M., Sarr, M.G., 2011. Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg. Oncol., 20(2):e84-e92.

[46]Sato, N., Rosty, C., Jansen, M., Fukushima, N., Ueki, T., Yeo, C.J., Cameron, J.L., Iacobuzio-Donahue, C.A., Hruban, R.H., Goggins, M., 2001. STK11/LKB1 Peutz-Jeghers gene inactivation in intraductal papillary-mucinous neoplasms of the pancreas. Am. J. Pathol., 159(6):2017-2022.

[47]Schwarz, A., Beger, H.G., 1996. Modification of Duodenum-Preserving Pancreatic Head Resection with Segmental Resection of the Duodenum: Experience with Four Cases (Oral Presentation). Annual Meeting of the Vereinigung Mittelrheinischer, Chirurgen, Ulm.

[48]Sheehan, M.K., Beck, K., Pickleman, J., Aranha, G.V., 2003. Spectrum of cystic neoplasms of the pancreas and their surgical management. Arch. Surg., 138(6):657-660.

[49]Sohn, T.A., Yeo, C.J., Cameron, J.L., Hruban, R.H., Fukushima, N., Campbell, K.A., Lillemoe, K.D., 2004. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann. Surg., 239(6):788-797.

[50]Solcia, E., Capella, C., Kloppel, G., 1997. Tumors of the Pancreas. Atlas of Tumor Pathology. 3rd Series, Fascicle 20, AFIP, Washington DC, p.103-114.

[51]Sperti, C., Pasquali, C., Chierichetti, F., Liessi, G., Ferlin, G., Pedrazzoli, S., 2001. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann. Surg., 234(5):675-680.

[52]Sperti, C., Pasquali, C., Decet, G., Chierichetti, F., Liessi, G., Pedrazzoli, S., 2005. F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J. Gastrointest. Surg., 9(1):22-28.

[53]Sperti, C., Bissoli, S., Pasquali, C., Frison, L., Liessi, G., Chierichetti, F., Pedrazzoli, S., 2007. 18-Fluorodeoxyglucose positron emission tomography enhances computed tomography diagnosis of malignant intraductal papillary mucinous neoplasms of the pancreas. Ann. Surg., 246(6):932-937.

[54]Sugiyama, M., Atomi, Y., 1999. Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas. Am. J. Gastroenterol., 94(2):470-473.

[55]Tanaka, M., Chari, S., Adsay, V., Fernandez-del Castillo, C., Falconi, M., Shimizu, M., Yamaguchi, K., Yamao, K., Matsuno, S., 2006. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology, 6(1-2):17-32.

[56]Tibayan, F., Vierra, M., Mindelzun, B., Tsang, D., McClenathan, J., Young, H., Trueblood, H.W., 2000. Clinical presentation of mucin-secreting tumors of the pancreas. Am. J. Surg., 179(5):349-351.

[57]Tseng, J.F., Warshaw, A.L., Sahani, D.V., Lauwers, G.Y., Rattner, D.W., Fernandez-del Castillo, C., 2005. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann. Surg., 242(3):413-419.

[58]Warshaw, A.L., Rattner, D.W., Fernandezdel-del Castillo, C., Z′graggen, K., 1998. Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch. Surg., 133(3):327-331.

[59]Wu, C.M., Fishman, E.K., Hruban, R.K., Schlott, W.D., Cameron, J.L., 1999. Serous cystic neoplasm involving the pancreas and liver: an unusual clinical entity. Abdom. Imaging, 24(1):75-77.

[60]Xiao, S.Y., 2012. Intraductal papillary mucinous neoplasm of the pancreas: an update. Scientifica, 2012:893632.

[61]Yoon, W.J., Brugge, W.R., 2012. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol. Clin. North Am., 41(1):103-118.

[62]Zamboni, G., Scarpa, A., Bogina, G., Iacono, C., Bassi, C., Talamini, G., Sessa, F., Capella, C., Solcia, E., Rickaert, F., et al., 1999. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am. J. Surg. Pathol., 23(4):410-422.

[63]Zamboni, G., Fukushima, N., Hruban, R.H., 2010. Mucinous Cystic Neoplasms of the Pancreas. In: Bosman, F.T., Carneiro, F., Hruban, R.H., Theise, N.D. (Eds.), World Health Organization Classification of Tumours of the Digestive System, 4th Ed. IARC, Lyon, p.300-303.

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