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JAMA Patient Page
September 20, 2016

Types of Pancreatic Cysts

JAMA. 2016;316(11):1226. doi:10.1001/jama.2016.9035

The pancreas is an important digestive organ located in the upper abdomen.

The pancreas serves 2 main functions: it produces enzymes that aid in digestion and it secretes important hormones, such as insulin, that help control metabolism. Cysts in the pancreas are not unusual. The most common cysts are called cystic neoplasms. These are fluid-filled sacs. Because some cysts can potentially be cancerous, an understanding of their risks and management is important.

A review article on pancreatic cyst disease was published in the May 3, 2016, issue of JAMA.

Signs and Symptoms of Pancreatic Cysts

Most patients with pancreatic cysts do not have symptoms. The cysts are usually found during imaging (such as a computed tomographic [CT] or magnetic resonance imaging [MRI] scan) done for other reasons. On occasion, a patient may have vague abdominal pain, jaundice (yellowing skin), or other abdominal symptoms. Cysts that make a mucus-like substance called mucin can obstruct ducts in the pancreas, which can inflame the pancreas and cause pancreatitis.

Types of Pancreatic Cysts

There are several kinds of pancreatic cysts. Those containing mucin may cause cancer. The most common type is called intraductal papillary mucinous neoplasm (IPMN). These cysts connect with the pancreatic duct, and their fluid usually has a large amount of digestive pancreatic enzymes. The cysts can occur in both men and women and are more common in people older than 50 years. IPMNs are further classified into subtypes based on the presence or absence of dilation of the main pancreatic duct. Cysts that are small, stable in size, and without worrisome features have a low risk of developing into cancers. Worrisome features are defined as a cyst larger than 3 cm, a thick cyst wall or one that “lights up” with contrast when 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 CT contrast, or a sudden change in the diameter of the pancreas’ main duct. When cysts are present in patients with jaundice, some part of the cyst is solid and lights up with CT contrast, or the main duct of the pancreas is larger than 10 mm, cancer may be present.

Another kind of mucinous cyst is called mucinous cystic neoplasm. Less common than IPMNs, these cysts have a distinct appearance when looked at by a pathologist (a doctor who studies the development of disease). Mucinous cystic neoplasms are almost exclusively found in middle-aged women and are usually located in the body and tail of the pancreas. These cysts also potentially can become cancerous.

A third kind of cyst is called a solid pseudopapillary neoplasm. These rare neoplasms have both solid and cystic components. Solid pseudopapillary neoplasms may also become cancerous and are more commonly found in younger women.

Another type of cyst is the serous cystadenoma. These cysts do not have mucin and have little to no risk of becoming cancerous. They are found more commonly in women older than 50 years.

Pancreatic ductal adenocarcinoma, the most common form of pancreas cancer, can look cystic in some cases. Pancreatic neuroendocrine tumors, another type of pancreas cancer, can also occasionally appear cystic and be confused with a benign cyst.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com/. Spanish translations are available in the supplemental content tab. A JAMA Patient Page on pancreatitis was published in the April 11, 2012, issue.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Stark A, Donahue TR, Reber HA, Hines OJ. Pancreatic cyst disease: a review. JAMA. 2016;315(17):1882-1893.

Topic: Digestive Disorders