ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding (Day One) | March 2025-Radiology Studies Case 1 -Pancreatic Cyst

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This document is a comprehensive analysis of pancreatic cysts, particularly focusing on a case study of a 65-year-old female who discovered a 3.5 cm incidental pancreatic cyst. Authored by Inessa Khaykis, MD, and Sarah Enslin, PA-C, it offers insights into differential diagnosis, evaluation, and management strategies for pancreatic cysts.<br /><br />Key points include:<br />- **Differential Diagnosis**: Pancreatic cysts can be benign like Pseudocysts or Serous Cystadenomas, premalignant like Intraductal Papillary Mucinous Neoplasms (IPMN), or malignant like Solid-Pseudopapillary Tumors (SPT).<br />- **Diagnosis & Evaluation**: Utilizes imaging (CT, MRI, EUS) to differentiate between cyst types, supplemented by EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for fluid analysis (CEA, amylase, molecular analysis).<br />- **Risk Stratification**: High-risk indications for malignancy include obstructive jaundice, enhancing mural nodules, and significant pancreatic duct dilation. Worrisome features include cysts larger than 3 cm and classic malignancy markers.<br />- **Management Strategies**: Asymptomatic benign cysts require monitoring with periodic imaging. Symptomatic or high-risk cysts may necessitate surgical interventions like EUS-guided drainage or resection.<br />- **Case Management**: With no high-risk stigmata reported, the case concludes with a surveillance plan, recommending MRI monitoring every 6-12 months and regular CA 19-9 and glucose checks.<br /><br />This study stresses the importance of a multi-disciplinary approach for better outcomes in managing pancreatic cysts, encouraging careful surveillance for asymptomatic or low-risk cases and prompt surgical intervention for high-risk cases.

Asset Subtitle

Inessa Khaykis, MD FASGE
Sarah Enslin, PA-C

Keywords

pancreatic cysts

differential diagnosis

imaging

EUS-FNA

risk stratification

management strategies

surveillance

multi-disciplinary approach

Inessa Khaykis

Sarah Enslin