Cystic tumours of the pancreas: a diagnostic dilemma.
BACKGROUND
Cystic neoplasm of the pancreas is an uncommon entity that encompasses a range of tumours with varying potential for malignancy. These tumours are frequently misdiagnosed as pseudocysts and are inappropriately managed.


METHODS
A retrospective review was undertaken of 18 cases of cystic tumours of the pancreas over an 8-year period in two large hospitals in Singapore.


RESULTS
All patients were Asian, with a younger age group (mean 43.5 years) and a lesser degree of female predominance (3.5:1 ratio) compared to other series. Pain was the most common symptom. Pre-operative diagnosis using ultrasound and computed tomography was not diagnostic in half of the cases and misdiagnosed as pseudocyst in a sixth. There were five serous cystadenomas, four mucinous cystadenomas, two mucinous cystadenocarcinomas, one mucinous cystadenocarcinoma with cystic degeneration in a ductal adenocarcinoma, three Frantz tumours, one acinar cell tumour, one glucagonoma, and one benign epithelial cyst. Two-thirds of tumours were malignant or had the potential to become malignant. Resection was curative in all cases, and no recurrence was noted at a mean follow-up of 34.5 months.


CONCLUSIONS
The difficulties with pre-operative diagnosis, the high incidence of tumours with potential malignancy, and the good outcome with resection, suggest that all suspected cystic tumours of the pancreas should be resected.
Ooi
L L
LL
Department of Surgery, Singapore General Hospital, Singapore. gsuopj@sgh.gov.sg
Ho
G H
GH
Chew
S P
SP
Low
C H
CH
Soo
K C
KC
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D018267:Carcinoma, Acinar Cell / Q000175:diagnosis / Q000473:pathology; D018282:Cystadenocarcinoma, Mucinous / Q000175:diagnosis / Q000473:pathology; D018291:Cystadenoma, Mucinous / Q000175:diagnosis / Q000473:pathology; D018293:Cystadenoma, Serous / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005935:Glucagonoma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000473:pathology; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000175:diagnosis; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000175:diagnosis; D012189:Retrospective Studies; D012737:Sex Factors; D012846:Singapore; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography