Other Cystic Lesions of the Pancreas

  • Abha GoyalEmail author
Part of the Essentials in Cytopathology book series (EICP, volume 28)


Pancreatic cyst lesions encompass a wide variety of entities ranging from nonneoplastic to neoplastic lesions with cystic degeneration. The cysts can show significant overlap in terms of imaging findings as well as clinical features. Cytology along with cyst fluid analysis plays a pivotal role in the preoperative characterization of these lesions. However, some lesions, especially the uncommon ones, may not be diagnosed accurately resulting in unnecessary surgery. This chapter will discuss the various aspects of pancreatic cystic lesions (other than the neoplastic mucinous cysts) including the clinical features, imaging findings, pathologic features, molecular genetics, and management.


Cystic lesions Pancreas Pancreatic cysts Serous cystadenoma (SCA) Pseudocyst Endoscopic ultrasound (EUS) 


  1. 1.
    Terris B, Fukushima N, Hruban RH. Serous neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of the diagestive system. 4th ed. Lyon: IARC; 2010. p. 296–9.Google Scholar
  2. 2.
    Zhang XP, Yu ZX, Zhao YP, Dai MH. Current perspectives on pancreatic serous cystic neoplasms: diagnosis, management and beyond. World J Gastrointest Surg. 2016;8:202–11.CrossRefGoogle Scholar
  3. 3.
    Tseng JF, Warshaw AL, Sahani DV, Lauwers GY, Rattner DW, Fernandez-del Castillo C. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg. 2005;242:413–9.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Ishigami K, Nishie A, Asayama Y, Ushijima Y, Takayama Y, Fujita N, et al. Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers. World J Radiol. 2014;6:36–47. Scholar
  5. 5.
    Choi JY, Kim MJ, Lee JY, Lim JS, Chung JJ, Kim KW, et al. Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. AJR Am J Roentgenol. 2009;193:136–42. Scholar
  6. 6.
    Belsley NA, Pitman MB, Lauwers GY, Brugge WR, Deshpande V. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2008;114:102–10. Scholar
  7. 7.
    Lilo MT, VandenBussche CJ, Allison DB, Lennon AM, Younes BK, Hruban RH, et al. Serous cystadenoma of the pancreas: potentials and pitfalls of a preoperative cytopathologic diagnosis. Acta Cytol. 2017;61:27–33. Scholar
  8. 8.
    Salomao M, Remotti H, Allendorf JD, Poneros JM, Sethi A, Gonda TA, et al. Fine-needle aspirations of pancreatic serous cystadenomas: improving diagnostic yield with cell blocks and α-inhibin immunohistochemistry. Cancer Cytopathol. 2014;122:33–9.CrossRefGoogle Scholar
  9. 9.
    Kaur G, Bakshi P, Singla V, Verma K. Clear cell neuroendocrine tumor of pancreas: endoscopic ultrasound-guided fine needle aspiration diagnosis of an uncommon variant. Cytojournal. 2016;13:7.–6413.178995.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Reid MD, Saka B, Balci S, Goldblum AS, Adsay NV. Molecular genetics of pancreatic neoplasms and their morphologic correlates: an update on recent advances and potential diagnostic applications. Am J Clin Pathol. 2014;141:168–80.CrossRefGoogle Scholar
  11. 11.
    Kloppel G, Hruban RH, Klimstra DS, Maitra A, Morohoshi T, Notohara, et al. Solid pseudopapillary neoplasm of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010. p. 327–30.Google Scholar
  12. 12.
    Sunkara S, Williams TR, Myers DT, Kryvenko ON. Solid pseudopapillary tumours of the pancreas: spectrum of imaging findings with histopathological correlation. Br J Radiol. 2012;85:e1140–4. Scholar
  13. 13.
    Ohara Y, Oda T, Hashimoto S, Akashi Y, Miyamoto R, Enomoto T, et al. Pancreatic neuroendocrine tumor and solid-pseudopapillary neoplasm: key immunohistochemical profiles for differential diagnosis. World J Gastroenterol. 2016;22:8596–604.CrossRefGoogle Scholar
  14. 14.
    Burford H, Baloch Z, Liu X, Jhala D, Siegal GP, Jhala N. E-cadherin/beta-catenin and CD10: a limited immunohistochemical panel to distinguish pancreatic endocrine neoplasm from solid pseudopapillary neoplasm of the pancreas on endoscopic ultrasound-guided fine-needle aspirates of the pancreas. Am J Clin Pathol. 2009;132:831–9.CrossRefGoogle Scholar
  15. 15.
    Singhi AD, Lilo M, Hruban RH, Cressman KL, Fuhrer K, Seethala RR. Overexpression of lymphoid enhancer-binding factor 1 (LEF1) in solid-pseudopapillary neoplasms of the pancreas. Mod Pathol. 2014;27:1355–63.CrossRefGoogle Scholar
  16. 16.
    Singhi AD, Chu LC, Tatsas AD, Shi C, Ellison TA, Fishman EK, et al. Cystic pancreatic neuroendocrine tumors: a clinicopathologic study. Am J Surg Pathol. 2012;36:1666–73. Scholar
  17. 17.
    Yoon WJ, Daglilar ES, Pitman MB, Brugge WR. Cystic pancreatic neuroendocrine tumors: endoscopic ultrasound and fine-needle aspiration characteristics. Endoscopy. 2013;45:189–94.–1325990.CrossRefPubMedGoogle Scholar
  18. 18.
    Morales-Oyarvide V, Yoon WJ, Ingkakul T, Forcione DG, Casey BW, Brugge WR, et al. Cystic pancreatic neuroendocrine tumors: the value of cytology in preoperative diagnosis. Cancer Cytopathol. 2014;122:435–44. Scholar
  19. 19.
    Cloyd JM, Kopecky KE, Norton JA, Kunz PL, Fisher GA, Visser BC, et al. Neuroendocrine tumors of the pancreas: degree of cystic component predicts prognosis. Surgery. 2016;160:708–13. Scholar
  20. 20.
    Ridtitid W, Halawi H, DeWitt JM, Sherman S, LeBlanc J, McHenry L, et al. Cystic pancreatic neuroendocrine tumors: outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up. Endoscopy. 2015;47:617–25.–1391712.CrossRefPubMedGoogle Scholar
  21. 21.
    Gonzalez Obeso E, Murphy E, Brugge W, Deshpande V. Pseudocyst of the pancreas: the role of cytology and special stains for mucin. Cancer. 2009;117:101–7.PubMedGoogle Scholar
  22. 22.
    Aghdassi AA, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM. Pancreatic pseudocysts—when and how to treat? HPB (Oxford). 2006;8:432–41. Scholar
  23. 23.
    Policarpio-Nicolas ML, Shami VM, Kahaleh M, Adams RB, Mallery S, Stanley MW, et al. Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts. Cancer. 2006;108:501–6.CrossRefGoogle Scholar
  24. 24.
    Raval JS, Zeh HJ, Moser AJ, Lee KK, Sanders MK, Navina S, et al. Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis. Mod Pathol. 2010;23:1467–76. Scholar
  25. 25.
    Adsay NV, Hasteh F, Cheng JD, Klimstra DS. Squamous-lined cysts of the pancreas: lymphoepithelial cysts, dermoid cysts (teratomas), and accessory-splenic epidermoid cysts. Semin Diagn Pathol. 2000;17:56–65.PubMedGoogle Scholar
  26. 26.
    Zavras N, Machairas N, Foukas P, Lazaris A, Patapis P, Machairas A. Epidermoid cyst of an intrapancreatic accessory spleen: a case report and literature review. World J Surg Oncol. 2014;12:92.–7819–12–92.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Horn AJ, Lele SM. Epidermoid cyst occurring within an intrapancreatic accessory spleen. A case report and review of the literature. JOP. 2011;12:279–82.PubMedGoogle Scholar
  28. 28.
    Othman M, Basturk O, Groisman G, Krasinskas A, Adsay NV. Squamoid cyst of pancreatic ducts: a distinct type of cystic lesion in the pancreas. Am J Surg Pathol. 2007;31:291–7.CrossRefGoogle Scholar
  29. 29.
    Hanson JA, Salem RR, Mitchell KA. Squamoid cyst of pancreatic ducts: a case series describing novel immunohistochemistry, cytology, and quantitative cyst fluid chemistry. Arch Pathol Lab Med. 2014;138:270–3.–0667-CR.CrossRefPubMedGoogle Scholar
  30. 30.
    Singhi AD, Norwood S, Liu TC, Sharma R, Wolfgang CL, Schulick RD, et al. Acinar cell cystadenoma of the pancreas: a benign neoplasm or non-neoplastic ballooning of acinar and ductal epithelium? Am J Surg Pathol. 2013;37:1329–35. Scholar
  31. 31.
    Chen AL, Misdraji J, Brugge WR, Ferrone CR, Pitman MB. Acinar cell cystadenoma: a challenging cytology diagnosis, facilitated by moray® micro-forceps biopsy. Diagn Cytopathol. 2017;45:557–60. Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineWeill-Cornell Medicine, New York Presbyterian HosptialNew YorkUSA

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