Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-Sun_17 Lennon Pancreatic incidentalomas cysts and IPMNs

Sun_17 Lennon Pancreatic incidentalomas cysts and IPMNs

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The document discusses the management of pancreatic cysts and intraductal papillary mucinous neoplasms (IPMNs), emphasizing diagnostic challenges and surveillance strategies. A case of a 70-year-old woman with a pancreatic cyst is presented to explore appropriate management techniques. The cyst appears to communicate with the main pancreatic duct but lacks nodules or solid components. Surveillance recommendations suggest patients unfit for surgery should not undergo further evaluation.<br /><br />Management of pancreatic cysts involves determining malignant potential: pseudocysts and serous cysts have no malignancy risk, while IPMNs and mucinous cystic neoplasms (MCNs) do have potential. An endoscopic ultrasound (EUS) is advised only when it will impact patient management. Cytology and molecular markers can aid diagnosis, with specific markers like KRAS, GNAS, and VHL indicating particular cyst types. <br /><br />Serous cysts have no malignant potential and require no routine surveillance, whereas MCNs have a low, but present, risk of malignancy, warranting surgery if high-risk features are identified. On the other hand, IPMNs are divided into main duct, branch duct, and mixed. Main duct and mixed type IPMNs show a higher malignancy risk, whereas branch duct IPMNs, though potentially malignant, often remain benign, requiring only surveillance.<br /><br />Surveillance intervals for IPMNs depend on risk factors and cyst features, with long-term stability indicating less risk of progression. Surveillance should stop if a patient has a low life expectancy or is unsuitable for surgery. Overall, careful evaluation and tailored management are key in handling pancreatic incidentalomas, based on cyst type, malignant potential, and patient health.

Keywords

pancreatic cysts

intraductal papillary mucinous neoplasms

diagnostic challenges

surveillance strategies

malignant potential

endoscopic ultrasound

cytology

molecular markers

management techniques

pancreatic incidentalomas