Cystic lesions of the pancreas (differential)

Last revised by Arlene Campos ◉ on 7 May 2024

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Campos A, Baba Y, et al. Cystic lesions of the pancreas (differential). Reference article, Radiopaedia.org (Accessed on 16 Mar 2025) https://doi.org/10.53347/rID-1195

DOI:

https://doi.org/10.53347/rID-1195

Permalink:

https://radiopaedia.org/articles/1195?embed_domain=external.radpair.com%2527%255b0%255dradiopaedia-icon-144.png

rID:

1195

Article created:

2 May 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

7 May 2024, Arlene Campos ◉

Disclosures:

At the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.

View Arlene Campos's current disclosures

Revisions:

34 times, by 19 contributors - see full revision history and disclosures

Systems:

Gastrointestinal, Hepatobiliary, Oncology

Sections:

Gamuts

Tags:

oncology

Synonyms:

Cystic pancreatic mass
Cystic pancreatic masses
Pancreatic cysts
Cystic pancreatic lesions
Pancreatic cystic lesions

The differential for cystic lesions of the pancreas includes:

unilocular
- pancreatic pseudocyst
- intraductal papillary mucinous neoplasm (IPMN)
- serous cystadenoma uncommonly uni/macrolocular
- simple pancreatic cyst
- cystic neuroendocrine tumor of the pancreas
diffuse pancreatic cysts
- pancreatic cysts occur in association with
  - von Hippel Lindau syndrome
  - autosomal dominant polycystic kidney disease (ADPKD)
  - isolated polycystic disease of the pancreas (IPDP)
  - pancreatic cystosis - in cystic fibrosis
macrocystic: multilocular
- mucinous cystic neoplasm of the pancreas: usually body and tail
- intraductal papillary mucinous neoplasm (IPMN)
- serous cystadenoma uncommonly uni/macrolocular
- acinar cell cystadenocarcinoma
- hydatid cyst ¹²
microcystic
- serous cystadenoma: usually head; 30% have a central scar
cystic with a solid component
- walled-off pancreatic necrosis
- macrocystic tumors can also have a solid component
- solid pseudopapillary tumor of the pancreas
- primary ductal pancreatic tumor with cystic degeneration
- cystic degeneration of islet cell tumors (neuroendocrine tumors)
  - insulinoma
  - glucagonoma
cystic teratoma
metastases to pancreas

Retroperitoneal lesions (extrinsic to the pancreas) can mimic pancreatic cystic lesions, when close to the gland. Examples include:

cystic lymphadenopathy (e.g. necrotic)
duodenal diverticulum

Practical points

the American College of Radiology (ACR) published guidelines on managing incidental cystic pancreatic lesions in 2017¹¹
(c.2022) evidence reports that the incidence of pancreatic cancer in asymptomatic patients with cysts <2 cm is similar to background rates ¹⁴

References

1. Macari M & Megibow A. Focal Cystic Pancreatic Lesions: Variability in Radiologists' Recommendations for Follow-Up Imaging. Radiology. 2011;259(1):20-3. doi:10.1148/radiol.11102437 - Pubmed
2. Sahani D, Kadavigere R, Saokar A, Fernandez-del Castillo C, Brugge W, Hahn P. Cystic Pancreatic Lesions: A Simple Imaging-Based Classification System for Guiding Management. Radiographics. 2005;25(6):1471-84. doi:10.1148/rg.256045161 - Pubmed
2. Kawamoto S, Horton K, Lawler L, Hruban R, Fishman E. Intraductal Papillary Mucinous Neoplasm of the Pancreas: Can Benign Lesions Be Differentiated from Malignant Lesions with Multidetector CT? Radiographics. 2005;25(6):1451-68; discussion 1468. doi:10.1148/rg.256055036 - Pubmed
4. Kalb B, Sarmiento J, Kooby D, Adsay N, Martin D. MR Imaging of Cystic Lesions of the Pancreas. Radiographics. 2009;29(6):1749-65. doi:10.1148/rg.296095506 - Pubmed
5. Vyas S, Markar S, Ezzat T, Ajit A. Cystic Lesions of the Pancreas: Current Trends in Approach and Management. Postgrad Med J. 2011;87(1025):207-14. doi:10.1136/pgmj.2010.097279 - Pubmed
6. Mathieu D, Guigui B, Valette P et al. Pancreatic Cystic Neoplasms. Radiol Clin North Am. 1989;27(1):163-76. - Pubmed
7. Kalb B, Sarmiento J, Kooby D, Adsay N, Martin D. MR Imaging of Cystic Lesions of the Pancreas. Radiographics. 2009;29(6):1749-65. doi:10.1148/rg.296095506 - Pubmed
8. Karoumpalis I & Christodoulou D. Cystic Lesions of the Pancreas. Ann Gastroenterol. 2016;29(2):155-61. doi:10.20524/aog.2016.0007 - Pubmed
9. Demos T, Posniak H, Harmath C, Olson M, Aranha G. Cystic Lesions of the Pancreas. AJR Am J Roentgenol. 2002;179(6):1375-88. doi:10.2214/ajr.179.6.1791375 - Pubmed
10. Khan A, Khosa F, Eisenberg R. Cystic Lesions of the Pancreas. AJR Am J Roentgenol. 2011;196(6):W668-77. doi:10.2214/AJR.10.4378 - Pubmed
11. Megibow A, Baker M, Morgan D et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14(7):911-23. doi:10.1016/j.jacr.2017.03.010 - Pubmed
12. Sorogy M, El-Hemaly M, Aboelenen A. Pancreatic Body Hydatid Cyst: A Case Report. Int J Surg Case Rep. 2015;6C:68-70. doi:10.1016/j.ijscr.2014.11.062 - Pubmed
13. D'Ippolito G. Incidental Pancreatic Cyst: Still a Lot of Road to Cover. Radiol Bras. 2018;51(4):V-VII. doi:10.1590/0100-3984.2018.51.4e1 - Pubmed
14. Nakhaei M, Bligh M, Chernyak V, Bezuidenhout A, Brook A, Brook O. Incidence of Pancreatic Cancer During Long-Term Follow-Up in Patients with Incidental Pancreatic Cysts Smaller Than 2 cm. Eur Radiol. 2022;32(5):3369-76. doi:10.1007/s00330-021-08428-1 - Pubmed