title: Pancreatic lesions in von Hippel-Lindau disease? A systematic review and meta-synthesis of the literature.
abstract: BACKGROUND
  von Hippel-Lindau (vHL) disease is a rare condition that leads to characteristic lesions within many different body systems. Pancreatic manifestations of vHL cover a wide spectrum of pathologies, and thus, accurate characterization and management is critical.
  
  
  METHODS
  A comprehensive and systematic text word and MeSH search of the medical literature was performed to identify studies where information regarding the prevalence, clinical characteristics, and management recommendations could be extracted.
  
  
  RESULTS
  Eleven studies were identified but 2 studies utilized the same data set. Of the 10 remaining studies, a total of 1,442 patients with vHL were available for analysis. Four hundred and twenty patients were examined for any type of pancreatic lesion, 362 for simple cysts or serous cystadenomas (SCAs), and 1,442 for neuroendocrine tumors (NETs). Of the 420 assessed for any pancreatic manifestation of vHL, 252 (60%) had a pancreatic lesion identified. Simple cysts that present as the sole manifestation of pancreatic disease were common and found in 169 of 362 (47%) patients. These are usually asymptomatic and do not normally require intervention. SCAs were reported in 39 of 362 (11%) patients and followed a similar benign course; resection is acceptable in symptomatic patients. NETs were identified in 211 of 1,442 (15%) patients, and 27 of 1,442 (2%) lesions behaved malignantly. Management of NETs depends on size, doubling time, and underlying genetics. Renal cell carcinoma is a characteristic in vHL, but there were no cases of pancreatic metastases identified from the included studies. Adenocarcinomas of the pancreas are not pathogenically linked to vHL.
  
  
  CONCLUSIONS
  This review highlights the wide spectrum and high prevalence of pancreatic lesions in vHL. Simple cysts and SCAs are benign, but NETs require careful observation due to their malignant potential.
authors.affiliation: Pancreatic Surgery Unit, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Charlesworth
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Verbeke
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Falk
authors.forename: Matthew
authors.initials: M
authors.lastname: Walsh
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Smith
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
mesh_terms: D018293:Cystadenoma, Serous / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015995:Prevalence; D006623:von Hippel-Lindau Disease / Q000150:complications*