Cystic Lesions in the Pancreas

Abstract

The pre- and intra-operative diagnosis of cystic pancreatic lesions is important since the management and prognosis varies between different lesions. The majority of pancreatic cystic lesions are pseudocysts that do not require major surgical resections. Fig. 5.1 shows the typical intra-operative management for cystic lesions in response to frozen section diagnosis. Generally the surgeon submits a portion of the cyst for frozen section, and the tissue should be entirely embedded for intra-operative diagnosis. If the clinical impression of pseudocyst is confirmed, the cyst will be drained rather than resected. If an epithelial lining is identified, the lesion will generally be resected and the final diagnosis made at permanent sections. A diagnosis of “benign” is not entirely helpful, as this does not address the surgeon’s primary question regarding the presence of a pseudocyst.