Pancreatic cystic neoplasms (PCNs) encompass a diverse spectrum of diseases with varying biological behaviors. With the increasing use of imaging techniques, their incidence has been rising. According to the WHO classification criteria, PCNs are primarily categorized into four types: serous cystic neoplasm (SCN), mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary neoplasm (SPN). Most patients with PCNs are asymptomatic, while a minority may experience abdominal discomfort due to tumor compression or develop obstructive jaundice or acute pancreatitis. Due to the varying malignancy risk and prognosis among different PCN types, clinical indications and surgical approaches differ significantly.
Serous Cystic Neoplasm (SCN)
SCNs are predominantly benign with a low risk of malignancy and a good prognosis. Regular monitoring and follow-up are generally recommended. Surgical treatment is recommended in cases where there is rapid tumor growth over a short period, the development of symptoms, or an inability to rule out malignancy.
Mucinous Cystic Neoplasm (MCN)
MCNs have malignant potential. Surgical treatment is indicated in patients with any of the following conditions: tumor diameter ≥4 cm, tumor-related symptoms, presence of mural nodules, solid components or eggshell-like calcifications in the cyst wall, or cytological findings that confirm or suggest malignancy.
Intraductal Papillary Mucinous Neoplasm (IPMN)
IPMNs are classified into three subtypes based on their relationship with the pancreatic duct: main duct, mixed type, and branch duct. Surgical treatment is recommended for high-risk patients with the following features: main pancreatic duct diameter ≥10 mm, enhancing mural nodule diameter ≥5 mm, tumor-related jaundice, or cytological findings that confirm or suggest malignancy. Patients without high-risk factors can be managed with regular follow-ups.
Solid Pseudopapillary Neoplasm (SPN)
SPNs are typically low-grade malignant tumors that are more commonly seen in young women. A small number of patients may develop liver or peritoneal metastases. Surgery is recommended as the preferred treatment upon confirmation of the diagnosis.