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Understanding the burden of pancreatic cystic lesions (PCLs) in the general population is important for clinicians and policymakers. In this systematic review, we sought to estimate the global prevalence of PCLs using magnetic resonance imaging (MRI) and to investigate factors that contribute to its variation. We searched MEDLINE, EMBASE, and Cochrane Central, from database inception through February 2023. We included full-text articles that reported the prevalence of PCLs using MRI in the general population. A proportional meta-analysis was performed, and the prevalence of PCLs was pooled using a random-effects model. Fifteen studies with 65,607 subjects were identified. The pooled prevalence of PCLs was 16% (95% confidence interval [CI], 13%–18%; I2 = 99%), most of which were under 10 mm. Age-specific prevalence of PCLs increased from 9% (95% CI, 7%–12%) at 50 to 59 years, to 18% (95% CI, 14%–22%) at 60 to 69 years, 26% (95% CI, 20%–33%) at 70 to 79 years, and 38% at 80 years and above (95% CI, 25%–52%). There was no difference in prevalence between sexes. Subgroup analysis showed higher PCL prevalence when imaging findings were confirmed by independent radiologist(s) (25%; 95% CI, 16%–33%) than when chart review alone was used (5%; 95% CI, 4%–7%; P <.01). There was no independent association of PCL prevalence with geographic location (Europe, North America, or Asia), MRI indication (screening vs evaluation of non-pancreatic pathology), enrollment period, sample size, magnet strength (1.5 vs 3 tesla), and MRI sequence (magnetic resonance cholangiopancreatography vs no magnetic resonance cholangiopancreatography). In this systematic review, the global prevalence of PCLs using a highly sensitive noninvasive imaging modality ranged between 13% and 18%. [ABSTRACT FROM AUTHOR]

• Distal pancreatectomy is the surgical operation of choice for cysts located on the body and tail of pancreas. • Distal pancreatectomy for pancreatic body cysts can result in loss of healthy distal pancreatic tissue. • Central pancreatectomy is an alternative surgical operation of choice of cysts located on pancreatic body. • Central pancreatectomy preserves distal healthy pancreas tissue. • Distal pancreas tissue can be anastomosed to the stomach when central pancreatectomy is performed. Surgical management of pancreatic cysts differ according to the specific location of the cyst on the pancreas. Cysts located on the pancreatic head require a radical procedure such as pancreaticoduodenectomy (Whipple procedure). Cysts of the pancreatic body or tail, however, require distal pancreatectomy as the standard surgical approach. An alternative surgical approach for cysts located in the mid-pancreas is central pancreatectomy with distal pancreaticogastrostomy. In this report, we present a case of a 22-year-old woman with a cyst located on the mid-pancreas consistent with a solid pseudopapillary neoplasia. Central pancreatectomy with distal pancreaticogastrostomy was the surgical technique of choice performed in this case. Central pancreatectomy has emerged as an alternative surgical approach to mid-pancreatic cysts which includes only the removal of a segment of the pancreas, thereby sparing the distal parenchyma. Compared with the traditional approach, this technique of partial resection of the pancreatic tissue is desirable due to its organ-sparing function. Central pancreatectomy with distal pancreaticogastrostomy can be an alternative to distal pancreatectomy for cysts located in the mid-pancreatic region. This rare procedure prevents any unnecessary healthy pancreatic tissue loss, reduces the risk of developing complications, and is an alternative treatment of choice to distal pancreatectomy. [ABSTRACT FROM AUTHOR]

Objective: In 2015, the American Gastroenterological Association recommended the discontinuation of radiographic surveillance after 5 years for patients with stable pancreatic cysts. The current study evaluated the yield of continued surveillance of pancreatic cysts up to and after 5 years of follow up. Methods: A prospectively maintained registry of patients evaluated for pancreatic cysts was queried (1995-2016). Patients who initially underwent radiographic surveillance were divided into those with <5 years and ≥5 years of follow up. Analyses for the presence of cyst growth (>5mm increase in diameter), cross-over to resection, and development of carcinoma were performed. Results: A total of 3024 patients were identified, with 2472 (82%) undergoing initial surveillance. The ≥5 year group (n = 596) experienced a greater frequency of cyst growth (44% vs. 20%; P < 0.0001), a lower rate of crossover to resection (8%vs 11%; P=0.02), and a similar frequency of progression to carcinoma (2% vs 3%; P = 0.07) compared with the <5 year group (n = 1876). Within the ≥5 year group, 412 patients (69%) had demonstrated radiographic stability at the 5-year time point. This subgroup, when compared with the<5 year group, experienced similar rates of cyst growth (19% vs. 20%; P = 0.95) and lower rates of cross-over to resection (5% vs 11%; P < 0.0001) and development of carcinoma (1% vs 3%; P = 0.008). The observed rate of developing cancer in the group that was stable at the 5-year time point was 31.3 per 100,000 per year, whereas the expected national age-adjusted incidence rate for this same group was 7.04 per 100,000 per year. Conclusion: Cyst size stability at the 5-year time point did not preclude future growth, cross-over to resection, or carcinoma development. Patients who were stable at 5 years had a nearly 3-fold higher risk of developing cancer compared with the general population and should continue long-term surveillance. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: Von Hippel-Lindau disease is associated with serous cysts in the pancreas and kidneys. In this study we determined the prevalence of pancreatic cysts occurring concurrently with other abdominal cysts and tested the hypothesis that these patients might represent a forme fruste of Von Hippel-Lindau disease and be more likely to be serous cysts. Methods: A retrospective chart review of patients undergoing endoscopic ultrasound of pancreatic cysts. Results: A total of 156 patients were included in the study. Eighty-five patients (54.8%) had cyst(s) in the pancreas and at least one other intra-abdominal cyst. These cysts included 24 (27.9%) serous cysts, 30 (34.9%), mucinous cysts, 6 (7%) adenocarcinoma and 25 (29.4%) unknowns. Seventy-one patients (45.2%) had isolated pancreatic cysts. These included 17 (23.9%) serous cysts, 28 (39.5%) mucinous cysts, 4 (5.6%) adenocarcinoma and 22 (31%) unknowns. The odds of serous cysts with concurrent extra-pancreatic and pancreatic cysts compared to odds of serous cysts with pancreatic cysts alone were 1.3 (95% CI: 0.6–2.9). Conclusions: Pancreatic cysts are associated with cysts in other abdominal organs in 54.8% patients. The prevalence of serous cysts was not higher amongst individuals with multiple organ cysts compared to those with only pancreatic cysts. [Copyright &y& Elsevier]

Experience with EUS guided fine-needle-aspiration of pancreatic tumors has demonstrated that regardless of size and location, most lesions in the pancreas are readily accessible by this technique. This has lead to the development of EUS guided placement of fiducials into pancreatic tumors to facilitate radiotherapy as well as injection of antitumor agents into cystic and solid pancreatic lesions. We review the technique for placing fiducials under EUS guidance into solid pancreatic neoplasms. To reduce risk of postprocedure pancreatitis, we recommend that no more than 3 fiducials be placed at a time, and that this procedure not be combined with fine-needle-aspiration for acquisition of tissue. We describe initial experience with TNFerade™, a replication deficient adenovirus vector that contains cDNA encoding for tumor necrosis factor, for treatment of adenocarcinoma of the pancreas. Finally, we review the current status of ethanol and a combination of ethanol and paclitaxel for ablation of pancreatic cysts. [Copyright &y& Elsevier]

We correlate the cytologic and histologic features of a squamous-lined pancreatic cystic lesion with a complex papillary architecture and an associated KRAS mutation, which to our knowledge has not been previously described. A 69 year-old woman presented with intermittent left upper quadrant pain. CT imaging revealed a 1 cm solid lesion in the pancreatic tail with peripheral calcification. Endoscopic ultrasound-guided fine needle biopsy showed a proliferation of epithelial cells with fibrovascular cores. An immunohistochemical stain for p40 was positive in the lesional cells. A distal pancreatectomy revealed a unilocular, cystic, well-circumscribed, soft and friable mass measuring 1.0 × 1.0 × 0.8 cm. Histologically, the cyst was lined by nonkeratinizing stratified squamous epithelium with a complex papillary architecture, filling the cyst lumen. Molecular sequencing revealed a KRAS G12V missense mutation. While the lesion shared some histologic features with the previously described "squamoid cyst of the pancreatic ducts", the complex papillary architecture and presence of a KRAS mutation are unique to the entity we describe herein and we propose the name "intraductal papillary squamous neoplasm of the pancreas." Reporting the cytomorphologic features of this novel entity may help in identification of similar lesions and understanding of the clinicopathologic significance. • Cytologic-histologic correlation of a novel squamous-lined pancreatic cystic lesion with complex papillary architecture • Fine needle biopsy cytology is compared to histology following distal pancreatectomy. • An associated KRAS mutation is identified. • The cytomorphologic differential diagnosis of such lesions is discussed. [ABSTRACT FROM AUTHOR]