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Abstract : |
Cystic lesions of pancreas (CLP) are common findings. They have been reported in over 20% of older patients. Although asymptomatic non-neo-plastic cysts are rare, the differentiation of neoplastic cysts from non-neoplastic is particularly important. Most CLP are asymptomatic. When symptoms are present, the most common are related to mild pancreatitis: recurrent pain, nausea, vomiting, sometimes with obstructive jaundice and weight loss. Diagnosis of CLP is based on detailed history, symptoms, radiological studies, endoscopic ultrasonography (EUS) with cyst fluid analysis, sono-elastography and serum tumor markers. Pancreatic epithelial neoplasia (PanIN) received special attention in recognition of intraductal papillary neoplasm (IPMN) and detection of precursors and precancerous ductal epithelial lesions. Clinical judgement such as careful history and radiological studies (computed tomography - CT, endoscopic retrograde cholangiopancreatography - ERCP) still remain the most reliable methods of differentiation between neoplastic and non-neoplastic pseudocyst. Amylase, cyst fluid CEA and CA72-4 are useful in identifying mucinous lesions. Molecular DNA amount and quality analysis, kiras point mutation, other gene markers, mutational analysis, proteomics, telomerase activity and ethanollavage might be use ful in the future. Analysis of serum determination of CEA and CA19-9 seems to be without any diagnostic benefit. Asymptomatic pseudocysts and serous cystadenoma can be left alone because neither have significant malignant potential. Asymtomatic patients with cyst fluid lacking mucin and CEA and patients with cystic lesions <3 cm and without solid component should be followed-up. Smali mucinous tumors are unlikely to be malignant., |
