Contents

Search

pancreatic pseudocyst

Etiology: - complication of pancreatitis - may be more common after acute pancreatitis than pancreatic cyst [1] Pathology: - obstruction of pancreatic ducts results in pancreatic exocrine secretions overflowing into adjacent pancreatic tissue - a fibrous wall forms to enclose the pancreatic secretions - a pseudocyst is thus enclosed by fibrous tissue - it contains - inflammatory pancreatic fluid (digestive enzymes) or - semisolid matter resulting from necrosis of pancreatic tissue digested by pancreatic secretions - not true cysts (no epithelial lining) thus not neoplasm - benign (not a malignant or premalignant lesion) Clinical manifestations: - generally takes at least 4 weeks to form after episode of acute pancreatitis - generally painless - often resolves spontaneously Laboratory: - CA 19-9 in serum may be a useful tumor marker Special laboratory: 1) endoscopic ultrasound if symptomatic or mucinous [1] - rule out adenocarcinoma 2) endoscopic cytology & biopsy 3) percutaneous fine-needle biopsy/aspiration - positive mucin stain &/or elevated CEA in aspirated fluid suggests mucinous adenocarcinoma Radiology: 1) computed tomography - septation, or a mass lesion is an indication for further evaluation 2) magnetic resonance imaging [1] Differential diagnosis: 1) pancreatic cyst 2) cystadenocarcinoma (generally painful) 3) cystadenoma (generally painless) 4) mucinous adenocarcinoma (malignant) 5) walled-of pancreatic necrosis Complications: - pseudocyst rupture or hemorrhage - may occur without warning - may be life-threatening Management: 1) most pseudocysts resolve without treatment 2) when symptoms become persistent or complications emerge including infection, drainage is indicated [3] - formerly, pseudocysts > 6 cm in size were drained [3] 3) pseudocyst drainage a) endoscopic drainage b) percutaneous catheter drainage c) surgical drainage - laparoscopy vs open surgery d) endoscopic drainage as effective as surgical drainage [4]

Related

pancreatic adenocarcinoma

General

pseudocyst pancreatic disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Barthet M et al, Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc 2008, 67:253 PMID: 18226686
  3. Gumaste VV, Aron J. Pseudocyst management: endoscopic drainage and other emerging techniques. J Clin Gastroenterol. 2010 May-Jun;44(5):326-31 PMID: 20142757
  4. Varadarajulu S et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013 Sep; 145:583 PMID: 23732774
  5. Tyberg A, Karia K, Gabr M et al Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol. 2016 Feb 21;22(7):2256-70. Review. PMID: 26900288 Free PMC Article
  6. Cleveland Clinic: Pancreatic Cysts and Pseudocysts http://my.clevelandclinic.org/disorders/pancreatitis/hic-pancreatic-cysts-and-pseudocysts.aspx