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<p>Pancreatic cystic neoplasms (PCNs) are increasingly recognized with the widespread use of cross-sectional imaging. They comprise a diverse group including intra-ductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), solid pseudopapillary neoplasms (SPNs) and cystic neuroendocrine tumors (cNETs), each differing in their clinico-pathological features, malignant potential and management. Accurate characterization, using a stepwise approach including high-quality cross-sectional imaging and endoscopic ultrasound with cyst fluid analysis when indicated, is crucial to distinguish high-risk lesions requiring surgery from benign cysts suitable for surveillance. Advances such as molecular testing, micro-forceps biopsy and confocal endomicroscopy have enhanced diagnostic precision. Current international guidelines recommend a risk-stratified approach—resection for main-duct IPMNs, all SPNs and MCNs ≥ 4&#xa0;cm or with high-risk features, while SCNs and small, stable branch-duct IPMNs may be observed. Indian surgical series demonstrate a younger age at presentation and a higher prevalence of MCN and SPN compared with western cohorts, but a lower rate of malignancy. Surgical resection, preferably in high-volume centres, remains the mainstay for high-risk cysts, whereas endoscopic ablation is emerging for select non-surgical candidates. Guidelines are many in this area with constant evolution, increasing focus on newer diagnostic modalities and post-operative endocrine and exocrine insufficiency.</p> Graphical Abstract <p></p>

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Cystic neoplasms of pancreas

  • 期刊论文

  • 发表日期：

    2026年4月23日

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  • Krithi Krishna Koduri,
  • Jahangeer Basha,
  • Sundeep Lakhtakia

摘要

Pancreatic cystic neoplasms (PCNs) are increasingly recognized with the widespread use of cross-sectional imaging. They comprise a diverse group including intra-ductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), solid pseudopapillary neoplasms (SPNs) and cystic neuroendocrine tumors (cNETs), each differing in their clinico-pathological features, malignant potential and management. Accurate characterization, using a stepwise approach including high-quality cross-sectional imaging and endoscopic ultrasound with cyst fluid analysis when indicated, is crucial to distinguish high-risk lesions requiring surgery from benign cysts suitable for surveillance. Advances such as molecular testing, micro-forceps biopsy and confocal endomicroscopy have enhanced diagnostic precision. Current international guidelines recommend a risk-stratified approach—resection for main-duct IPMNs, all SPNs and MCNs ≥ 4 cm or with high-risk features, while SCNs and small, stable branch-duct IPMNs may be observed. Indian surgical series demonstrate a younger age at presentation and a higher prevalence of MCN and SPN compared with western cohorts, but a lower rate of malignancy. Surgical resection, preferably in high-volume centres, remains the mainstay for high-risk cysts, whereas endoscopic ablation is emerging for select non-surgical candidates. Guidelines are many in this area with constant evolution, increasing focus on newer diagnostic modalities and post-operative endocrine and exocrine insufficiency.

Graphical Abstract