%0 Journal Article
%T Interdisciplinary Management of Cystic Neoplasms of the Pancreas
%A Linda S. Lee
%A Thomas Clancy
%A Vivek Kadiyala
%A Shadeah Suleiman
%A Darwin L. Conwell
%J Gastroenterology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/513163
%X Cystic neoplasms of the pancreas are increasingly recognized due to the frequent use of abdominal imaging. It is reported that up to 20% of abdominal cross-sectional scans identify incidental asymptomatic pancreatic cysts. Proper characterization of pancreatic cystic neoplasms is important not only to recognize premalignant lesions that will require surgical resection, but also to allow nonoperative management of many cystic lesions that will not require resection with its inherent morbidity. Though reliable biomarkers are lacking, a wide spectrum of diagnostic modalities are available to evaluate pancreatic cystic neoplasms, including radiologic, endoscopic, laboratory, and pathologic analysis. An interdisciplinary approach to management of these lesions which incorporates recent, specialty-specific advances in the medical literature is herein suggested. 1. Introduction With improvements in abdominal radiologic imaging, incidental pancreatic cystic neoplasms are increasingly discovered in as many as 20% of patients undergoing computed tomography (CT) or magnetic resonance imaging (MRI) for nonpancreatic indications. The proper management of these lesions is critical [1¨C5]. The differential diagnoses for incidental pancreatic cystic lesions include the following: (1) benign serous cystadenoma or (2) premalignant mucinous cystic lesions, which are categorized into mucinous cystic neoplasm (MCN), branch duct intraductal papillary mucinous neoplasm (BD-IPMN), main duct IPMN (MD-IPMN), or mixed IPMN. Based on the histologic type, pancreatic cystic neoplasms may have low or high risk for malignant transformation. Unfortunately, the imaging characteristics of pancreatic cysts can be similar, making differentiation between benign and premalignant conditions difficult. In addition, current cyst fluid analysis techniques fail to clearly distinguish among the cysts. The definitive classification of pancreatic cysts is crucially important since precancerous lesions may require surgical resection, while others that are benign or indolent can be observed. An interdisciplinary approach incorporating medical pancreatology, therapeutic endoscopy, and pancreatic surgery is critical to the evaluation of patients with cystic neoplasms of the pancreas. We provide a brief overview of the clinical problem followed by interdisciplinary management algorithms based on the current literature, including recent guidelines from the major gastrointestinal and surgical societies. 2. Clinical and Pathologic Features Unlike most hepatic and renal cysts, pancreatic cystic lesions raise
%U http://www.hindawi.com/journals/grp/2012/513163/