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Pancreatic Cancer pp 1131-1156 | Cite as

Management of Cystic Neoplasms of the Pancreas Including IPMNs

  • C. Tjaden
  • Thilo Hackert
  • Markus W. Büchler
Reference work entry

Abstract

The management of cystic pancreatic lesions fundamentally depends on knowing the cyst type and the risk or presence of malignancy. Only serous cystic neoplasms (SCN) are generally benign lesions, while mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) as the most common cystic lesion and solid-pseudopapillary neoplasm (SPN) show different risk profiles for the development of invasive cancer. Once a cystic lesion is detected, the clinical decision is necessary if an upfront resection with the inherent morbidity of pancreatic surgery should be performed or if an observational management can be preferred. Whereas these strategies are clearly defined for certain cystic lesions including SCN, MCN, and SPN, the management of IPMN, especially with regard to the branch-duct type, remains partly controversial, and current guidelines differ with regard to indications for surgery and/or surveillance. The present chapter gives an overview on the different types of pancreatic cystic neoplasms and current diagnostic modalities. Furthermore, the indications for surgery, the variety of surgical resections, and the surveillance/follow-up strategies are discussed in the light of the current literature and guidelines.

Keywords

Intraductal papillary mucinous neoplasm Mucinous cystic neoplasm Serous cystic neoplasm Solid-pseudopapillary neoplasm 

Abbreviations

AGA

American Gastroenterological Association

BD

Branch duct

CDX

Caudal-related homeobox transcription factor

CT

Computer tomography

ERCP

Endoscopic retrograde cholangiopancreaticography

EUS

Endoscopic ultrasound

FNA

Fine needle aspiration

IAP

International Association of Pancreatology

IPMN

Intraductal papillary mucinous neoplasm

KRAS

Kirsten rat sarcoma viral oncogene homolog

MCN

Mucinous cystic neoplasm

MD

Main duct

MRCP

Magnetic resonance cholangiopancreaticography

MRI

Magnetic resonance imaging

MUC

Mucin protein

NECP

Neuroendocrine cyst of the pancreas

PanIN

Pancreatic intraepithelial neoplasm

PDAC

Pancreatic ductal adenocarcinoma

SCN

Serous cystic neoplasm

SPN

Solid-pseudopapillary neoplasm

VHL

von Hippel-Lindau

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General, Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

Section editors and affiliations

  • James L. Abbruzzese
    • 1
  • Raul A. Urrutia
    • 2
  • John Neoptolemos
    • 3
  • Markus W. Büchler
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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