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PANCREATIC CYSTS
Category: Pediatric Surgery
Abstract : Pancreatic Cysts : Pancreatic cystic lesions are usually inflammatory pseudocyst
(90%) or neoplastic process (10%). Distinguishing between them is essential for
appropriate surgical therapy. Non-inflammatory neoplastic cysts in children
are very rare ductal lesions with a spectrum of histologic characteristics and
favorable outcomes. Histologically they include retention cysts,
lympho
Pancreatic Cysts : Pancreatic cystic lesions are usually inflammatory pseudocyst
(90%) or neoplastic process (10%). Distinguishing between them is essential for
appropriate surgical therapy.
Non-inflammatory neoplastic cysts in children
are very rare ductal lesions with a spectrum of histologic characteristics and
favorable outcomes.
Histologically they include retention cysts,
lymphoepithelial cysts, papillary cystic tumors, benign serous cystadenoma,
mucinous tumors and mucinous cystadenocarcinoma. Most reported cases occur in
females during adolescent years. Mode of presentation includes mild upper
abdominal pain and palpable mass.
Clinical, radiographic and
intraoperative frozen section are non-reliable methods in distinguishing the
different types of pancreatic cysts. Preoperative cyst fluid obtained by US or
CT-guided percutaneous aspiration can be analyzed for viscosity (mucoid,
viscous, serous), chemical (amylase, lipase), tumor markers (CEA, CA 19-9,
CA125) and cytology characteristics. High CEA levels (> 25 ng/ml) indicate
that the cyst is either malignant or mucinous (premalignant) type. Higher levels
of CA 19-9 suggest pseudocysts and serous cystadenomas. Very high CA 125 levels
appear predictive of malignancy. Viscosity above 1.63 suggests mucinous tumors.
Amylase and lipase content should be low in true pancreatic cysts. Cytology
analysis is insensitive unless positive for tumor cells. When the nature of the
pancreatic cyst cannot be definitively establish by the above methods surgical
resection is indicated.
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