JAMA PATIENT PAGE | Digestive Disorders Types of Pancreatic Cysts

The pancreas is an important digestive organ located in the upper abdomen. The pancreas serves 2 main functions: it produces enzymes that aid Pancreatic Cysts in digestion and it secretes important hormones, such as insulin, that Location of the Pancreas Regions of the Pancreas help control metabolism. Cysts in the pancreas are not unusual. The Stomach most common cysts are called cystic neoplasms. These are fluid- Tail Body filled sacs. Because some cysts can potentially be cancerous, an un- LIVER Neck derstanding of their risks and management is important. Spleen Head A review article on pancreatic cyst disease was published in the Gallbladder Pancreas May 3, 2016, issue of JAMA. Intestine

Signs and Symptoms of Pancreatic Cysts Types of Pancreatic Cysts Most patients with pancreatic cysts do not have symptoms. The cysts Main pancreatic duct are usually found during imaging (such as a computed tomographic Bile duct [CT] or magnetic resonance imaging [MRI] scan) done for other rea- Serous sons. On occasion, a patient may have vague abdominal pain, cystadenoma

jaundice (yellowing skin), or other abdominal symptoms. Cysts that CROCRROR O SSS-SS-- SECSSEEECC TIOTTIO N Solid pseudopapillary make a mucus-like substance called mucin can obstruct ducts in the OF PPANPAAANN CRECRC RREE ASA S neoplasm pancreas, which can inflame the pancreas and cause pancreatitis. Mucinous cystic neoplasm

Types of Pancreatic Cysts Branch duct intraductal papillary There are several kinds of pancreatic cysts. Those containing mu- mucinous neoplasm (IPMN) cin may cause cancer. The most common type is called intraductal papillary mucinous neoplasm (IPMN). These cysts connect with pseudopapillaryneoplasmsmayalsobecomecancerousandaremore the pancreatic duct, and their fluid usually has a large amount of di- commonly found in younger women. gestive pancreatic enzymes. The cysts can occur in both men and Another type of cyst is the serous cystadenoma. These cysts women and are more common in people older than 50 years. IPMNs do not have mucin and have little to no risk of becoming cancerous. are further classified into subtypes based on the presence or ab- They are found more commonly in women older than 50 years. sence of dilation of the main pancreatic duct. Cysts that are small, Pancreatic ductal adenocarcinoma, the most common form of stable in size, and without worrisome features have a low risk of de- pancreas cancer, can look cystic in some cases. Pancreatic neuro- veloping into cancers. Worrisome features are defined as a cyst larger endocrine tumors, another type of pancreas cancer, can also occa- than 3 cm, a thick cyst wall or one that “lights up” with contrast when sionally appear cystic and be confused with a benign cyst. a CT scan is done, size of the main duct of the pancreas measuring 5 to 9 mm, a nodule on the wall of the cyst that does not light up with CTcontrast,orasuddenchangeinthediameterofthepancreas’main FOR MORE INFORMATION duct. When cysts are present in patients with jaundice, some part • National Institutes of Health of the cyst is solid and lights up with CT contrast, or the main duct www.nlm.nih.gov/medlineplus/ency/article/000272.htm of the pancreas is larger than 10 mm, cancer may be present. • Mayo Clinic Anotherkindofmucinouscystiscalledmucinouscysticneoplasm. www.mayoclinic.org/diseases-conditions/pancreatic-cysts/basics LesscommonthanIPMNs,thesecystshaveadistinctappearancewhen /definition/con-20024331 looked at by a pathologist (a doctor who studies the development of disease). Mucinous cystic neoplasms are almost exclusively found in To find this and previous JAMA Patient Pages, go to the Patient Page middle-aged women and are usually located in the body and tail of the link on JAMA’s website at www.jama.com/. Spanish translations are available in the supplemental content tab. A JAMA Patient Page on pancreas. These cysts also potentially can become cancerous. pancreatitis was published in the April 11, 2012, issue. A third kind of cyst is called a solid pseudopapillary neoplasm. These rare neoplasms have both solid and cystic components. Solid

Authors: Ibrahim Nassour, MD; Michael A. Choti, MD, MBA The JAMA Patient Page is a public service of JAMA. The information and Conflict of Interest Disclosures: The authors have completed and submitted the recommendations appearing on this page are appropriate in most instances, but they ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page Source: Stark A, Donahue TR, Reber HA, Hines OJ. Pancreatic cyst disease: a review. may be photocopied noncommercially by physicians and other health care JAMA. 2016;315(17):1882-1893. professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

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