الفهرس 
Anatomy of the pancreasOnly 14 pages are availabe for public view
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Abstract
Cystic neoplasms of the pancreas are relatively rare but constitute an increasingly important category with a challenging differential diagnosis. The vast majority of cystic neoplasia is either benign tumors or low-grade malignancies with indolent behavior. Serous and squamous cystic lesions of the pancreas are typically benign. Cysts with mucinous lining, however, carry the risk of malignant transformation. Many are associated with invasive carcinoma, and therefore their thorough sampling and careful examination are of utmost importance.
Macroscopic examination plays a crucial role in the diagnosis of cystic neoplasia, especially those of the mucinous type. Subclassification of IPMNs into branch or main duct types relies heavily on macroscopic examination and guided sampling. Along the same lines, the lack of gross ductal communication, an important criterion for the diagnosis of MCNs, is also established by the macroscopic findings. It is also important to examine a cystic lesion thoroughly before it can be diagnosed as a ‘pseudocyst’. SPTs commonly appear clinically (and grossly) like a pseudocyst, and even ordinary ductal adenocarcinomas or endocrine neoplasia may present as a pseudocyst.
The evaluation of cystic lesions of the pancreas remains a process in evolution. Significant advances have been made in expanding our understanding of these lesions and in the refinement of our diagnostic approach. A comprehensive diagnostic strategy which incorporates data from patient history, lesion imaging, EUS, and cyst fluid analysis will provide an accurate diagnosis in most cases.
Resection is still recommended in all surgically fit patients with MD-IPMN or MCN. The indications for resection of BD-IPMN are more conservative. BD-IPMNs of >3 cm without “high-risk stigmata” can be observed without immediate resection. Methods and intervals of surveillance are proposed with an algorithm in view of “high-risk stigmata” and “worrisome features”. The issue of whether the interval of surveillance can be lengthened after 2 years of no change is controversial. Some authors advocate continuation of surveillance every 6 months in view of the relatively high incidence of PDAC in patients with BD-IPMN.