Pancreatic Pseudocysts Differential Diagnoses

Updated: Nov 21, 2016
  • Author: Louis R Lambiase, MD, MHA; Chief Editor: BS Anand, MD  more...
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DDx

Diagnostic ConsiderationsImportant considerationsOther problems to be considered

Take care not to misdiagnose and/or treat a cystic neoplasm of the pancreas as a pseudocyst.

It is important to recognize and treat complications.

When evaluating patients with suspected pancreatic pseudocysts, also consider the following conditions:

  • Organized pancreatic necrosis
  • Acute pancreatic fluid collections
  • Serous cystadenoma of the pancreas
  • Mucinous cystadenoma of the pancreas (see below)
  • Mucinous cystadenocarcinoma (see below)
  • Pancreatic retention cyst

Note that the 2015 American Gastroenterological Association recommendations for the diagnosis and management of asymptomatic neoplastic pancreatic cysts include the following [3] :

  • For asymptomatic mucinous cysts, a 2-year interval is recommended for a cyst of any size undergoing surveillance, with surveillance being stopped after 5 years if there is no change.
  • Perform surgery only if there is more than one concerning feature on magnetic resonance imaging (MRI) confirmed on endoscopic ultrasonography (EUS) and only in centers with high volumes of pancreatic surgery, and there should be no surveillance after surgery if there is no invasive cancer or dysplasia.
  • The risk of malignant transformation of pancreatic cysts is approximately 0.24% per year, and the risk of cancer in cysts without a significant change over a 5-year period is likely to be lower.
  • The small risk of malignant progression in stable cysts is likely outweighed by the costs of surveillance and the risks of surgery.
  • Positive cytology on EUS-guided fine-needle aspiration (FNA) has the highest specificity for diagnosing malignancy; if there is a combination of high-risk features on imaging, then this is likely to increase the risk of malignancy even further. Similarly, if a cyst has both a solid component and a dilated pancreatic duct (confirmed on both EUS and MRI), the specificity for malignancy is likely to be high even in the absence of positive cytology.

Differential Diagnoses