Opinion Review
Copyright ©The Author(s) 2019.
World J Gastroenterol. May 21, 2019; 25(19): 2271-2278
Published online May 21, 2019. doi: 10.3748/wjg.v25.i19.2271
Table 1 Differential diagnosis of pancreatic cystic lesions
IPMNMCNPCSCNNETSPN
SexM = FF > MM > FF > MM = FF > M
Age (yr)40-8030-70Variable50-7020-508-40
Clinical settingAsymptomatic PancreatitisAsymptomatic Pain/massPancreatitisAsymptomatic Pain/massAsymptomatic Pain/massAsymptomatic Pain/mass
AppearanceDilated MPD and/or branch-ducts. Fish- mouth papilla.Well-circumscribed macrocystic lesionUnilocular. Thin/thick- walled. Acute/chronic pancreatitis.Microcystic with central fibrosis/ macrocystic and solid variants are possibleAssociated massMixed solid and cystic with well-defined borders.
LocationHeadBody/tailAnywhereAnywhereBody/tailBody/tail
Communication with MPDYesRareYes/noNoNoNo
CalcificationNoPeripheralRelated to chronic pancreatitisCentralIn necrotic lesions.In necrotic lesions.
FluidClear/viscousClear/viscousThin/darkClear/wateryThinBloody
EpitheliumColumnar papillary mucinous.Columnar/cuboidal mucinous.No epithelium. Inflammatory cells.Serous cuboidal. Stain for glycogen.Endocrine. Stain for synaptophysin, chromograninStain for vimentin, α1-antitrypsin, β-catenin
Malignant potentialHighHighNoneRareLowLow
Cyst fluid CEAUsually HighHighLowVery lowVery lowLow
Cyst fluid amilaseHighVariableHighLowLowLow
Table 2 Comparison between cyst fluid carcinoembryonic antigen and glucose levels, using a carcinoembryonic antigen cut-off suggestive of mucinous cystic neoplasms
Glucose levelsCEA levels< 50 mg/dL≥ 50 mg/dLTotal
192 ng/mL33336a
< 192 ng/mL255479
Total5857115
Table 3 Comparison between cyst fluid carcinoembryonic antigen and glucose levels, using a carcinoembryonic antigen cut-off suggestive of serous cystic neoplasms
Glucose levelsCEA levels< 50 mg/dL50 mg/dLTotal
≥ 5 ng/mL55964a
< 5 ng/mL34851
Total5857115