Cystic tumours of the pancreas: A diagnostic dilemma

Background: Cystic neoplasm of the pancreas is an uncommon entity that enco mpasses a range of tumours with varying potential for malignancy. These rum ours are frequently misdiagnosed as pseudocysts and are inappropriately man aged. Methods: A retrospective review was undertaken of 18 cases of cystic tumour s of the pancreas over an 8-year period in two large hospitals in Singapore . Results: All patients were Asian, with a younger age group (mean 43.5 years ) and a lesser degree of female predominance (3.5:1 ratio) compared to othe r series. Pain was the most common symptom. Pre-operative diagnosis using u ltrasound and computed tomography was not diagnostic in half of the cases a nd misdiagnosed as pseudocyst in a sixth. There were five serous cystadenom as, four mucinous cystadenomas, two mucinous cystadenocarcinomas, one mucin ous cystadenocarcinoma with cystic degeneration in a ductal adenocarcinoma, three Frantz tumours, one acinar cell tumour, one glucagonoma, and one ben ign epithelial cyst. Two-thirds of tumours were malignant or had the potent ial to become malignant. Resection was curative in all cases, and no recurr ence was noted at a mean follow-up of 34.5 months. Conclusions: The difficulties with pre-operative diagnosis, the high incide nce of tumours with potential malignancy, and the good outcome with resecti on, suggest that all suspected cystic tumours of the pancreas should be res ected.