Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 544

Cystic lesions of the pancreas are very common findings in the era of modern cross‐sectional imaging and are usually discovered incidentally. Recent studies have shown that up to 40% of adults will have a small pancreatic cyst noted incidentally on abdominal MRI scans.²¹

Broadly speaking, pancreatic cysts can be divided into neoplastic and non‐neoplastic categories. Of the non‐neoplastic cysts, the majority are inflammatory lesions, most commonly pseudocysts, which can be encountered as a sequalae of acute pancreatitis. These inflammatory cysts are variably symptomatic, and depending on their anatomical location and morphology, EUS sampling or drainage may be indicated and should be referred for evaluation by a gastroenterologist. Other non‐neoplastic cysts are fairly rare but include true cysts, retention cysts, mucinous non‐neoplastic cysts, and lymphoepithelial cysts, all of which may be difficult to definitely diagnose and are beyond the scope of this chapter.

Neoplastic cysts are quite common, and certain categories of pancreatic cystic neoplasms may require surveillance or even consideration of resection because of malignancy risk. The two most common types of pancreatic cystic neoplasms are intraductal papillary mucinous neoplasms (IPMNs), which are precancerous and typically require surveillance, and serous cystadenomas (SCAs), which are typically benign and may not require surveillance. There are several other, less common, pancreatic cystic neoplasms, including mucinous cystic neoplasm (MCN) and pseudopapillary neoplasm, extensive discussion of which is beyond the scope of this chapter.

As a general rule, any pancreatic cystic lesion greater than 1 cm should, even if incidentally discovered, be referred to a gastroenterologist to help determine appropriate additional testing and/or surveillance modality and interval. If there is uncertainty regarding the nature of a pancreatic cyst <1 cm in size, then interval MRCP imaging (typically at 6–12 months) or referral to a gastroenterologist are both reasonable considerations; however, the clinical significance of a diminutive pancreatic cyst in an elderly patient is questionable, particularly if other chronic health conditions are present.

Table 21.1 Pancreatic endocrine tumours.

Type	Age at diagnosis (years)	Five‐year survival rate (%)	Clinical characteristics
Insulinoma	50–60	90	Fatigue, hypoglycaemia
Gastrinoma	60–70	55	Gastric pain, weight loss
Glucagonoma	50–60	90	Weight loss, diabetes, rash
Somatostatinoma	60–70	30	Diabetes, gallstones, weight loss, steatorrhea
VIPoma	40–60	45	Flushing
Pancreatic peptideomas	40–60	40	None