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Copyright ©2010 Baishideng Publishing Group Co.
World J Gastrointest Surg. Oct 27, 2010; 2(10): 331-336
Published online Oct 27, 2010. doi: 10.4240/wjgs.v2.i10.331
Table 1 Distinguishing features of pancreatic cystic lesions[1,14-19]
Typical characteristicsIPMNMCNSCPSEUDOSPNLECcNETcPDAC
Age GroupElderlyMiddleMiddle-ElderlyAnyYoungElderlyMiddle-ElderlyElderly
Gender70% male95% female> 50% female> 50% male80%-90% female80% male50% each> 50% male
HistoryAsx; Pain; ± jaundiceAsx; Pain; nauseaAsx; VHLPancreatitisAsx; Pain; nauseaAsxAsx; Fxnl; MENAsx; Pain; ± jaundice
Location in pancreasHead in 70%; Multi-focalBody/Tail in 95%AnywhereAnywhereAnywherePeripheralAnywhereAnywhere
ShapeOvoidSpheroidOvoidSpheroidOvoidOvoidSpheroidVariable
LocularityAnyUni or OligoOligo or MultiUniOligo or MultiOligoUniAny
Duct Com-municationCommonNoNoCommonNoNoNoSome
CalcificationNoNoCentral sunburstNoSomeNoSomeNo
Cyst fluid appearanceViscous, clear, mucViscous, clear, mucThin, clear, nonmucOpaque, bloody/necrotic debrisOpaque, bloody/necrotic debrisNonmuc, crystalline debrisNonmucThin
High CEA/Mucina++-----±
High Ca 19-9±±-----±
High amylase+--+---±
EpitheliumColumnar, PapillaryColumnarCuboidalNo epitheliumPoorly cohesive cells with nuclear groovesSquamoidUniformGland-forming
StromaFibroticOvarianFibroticFibroticSometimes hyalinizedLymphoidSometimes hyalinizedFibrotic
Table 2 Key questions to aid in making likely diagnoses[19]
Key questionLikely diagnoses to consider
Demographics and historyMale?MCN unlikely
No history of pancreatitis?PSEUDO unlikely
Young female?SPN
History of MEN?cNET
History VHL?SC
ImagingSpheroid?PSEUDO or MCN
Central sunburst calcification?SC
Location in head?MCN unlikely
Cyst fluidNo CEA/mucin?IPMN or MCN unlikely
High CEA, high amylase?IPMN
High CEA, low amylaseMCN
Low CEA, high amylase?PSUEDO
High amylase?IPMN or PSEUDO
HistologyEpithelial lining?PSEUDO unlikely
Ovarian stroma?MCN