Management of Mucinous Cystic Neoplasms

Pancreatic cystic lesions (PCLs) are commonly encountered as incidental radiological findings. The differentials include both neoplastic and neoplastic lesions. Management depends on identifying the type of cystic lesion based on a combination of clinical presentation, radiological characteristics, and cystic fluid and serum biomarkers. Mucinous cystic neoplasms represent neoplastic lesions with significant malignant potential. Clinically, they are usually asymptomatic and incidentally detected in middle-aged females. Morphologically, they are oligomacrocystic with no communication with the main pancreatic duct. Adequate characterization is required to gauge the risk of malignancy and includes a combination of radiological findings on contrast-enhanced MRI or EUS with an option for EUS-guided sampling of the cystic fluid along with blood biomarkers. Patients with high-risk features warrant upfront surgical resection if they are fit for surgery. Those who are unfit for surgery or do not have high-risk stigmata or worrisome features may be kept on routine surveillance with CE-MRI or EUS at regular intervals, as suggested by various guidelines. Herein, we discuss the diagnosis and optimal management of mucinous cystic neoplasms along with the recommendations from various guidelines.