Pancreatic Cysts

  • Medical Author:
    Jay W. Marks, MD


  • Medical Editor: Bhupinder Anand, MD

What is the pancreas?





Illustration of the Pancreas
Illustration of the Pancreas

What are pancreatic cysts?


Different types of cysts contain different types of fluids. For example, pseudocysts that form after an attack of acute pancreatitis contain digestive enzymes, such as amylase, in high concentrations. Mucinous cysts contain mucus (a proteinaceous liquid) produced by the mucinous cells that form the inside lining of the cyst.

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What are the symptoms of pancreatic cysts?

  • The symptoms of pancreatic cysts depend on their size and location. Small (less than two cm) cysts usually cause no symptoms. Large pancreatic cysts can cause abdominal pain and back pain presumably by exerting pressure on the surrounding tissues and nerves.
  • Small or large cysts in the head of the pancreas also may cause jaundice (yellowing of the skin and eyes with darkening of the urine) due to obstruction of the common bile duct. (Obstruction causes bile to back up and forces bilirubin--the chemical that produces jaundice--back into the bloodstream and forces it to be excreted in the urine.)
  • On rare occasions, large pseudocysts can compress the stomach or the duodenum leading to obstruction to the movement of food in the intestines, resulting in abdominal pain and vomiting.

What are the causes of pancreatic cysts?

There are two major types of pancreatic cysts; pseudocysts (inflammatory cysts) and true cysts (non-inflammatory cysts). Inflammatory cysts are benign, whereas non-inflammatory cysts can be benign, precancerous, or cancerous.


Most of the inflammatory cysts of the pancreas are pancreatic pseudocysts. Pseudocysts of the pancreas result from pancreatitis (inflammation of the pancreas). The common causes of pancreatitis include alcoholism, gallstones, trauma, and surgery. The fluid inside the pseudocysts represents liquefied dead pancreatic tissue, cells of inflammation, and a high concentration of digestive enzymes that are present in pancreatic exocrine secretions. (Most pseudocysts have connections with the pancreatic ducts.) Most pseudocysts caused by acute pancreatitis resolve spontaneously (without treatment) within several weeks. Pseudocysts that need treatment are those that persist beyond six weeks and are causing symptoms such as pain, obstruction of the stomach or duodenum, or have become infected.

True cysts

  • Serous cyst adenomas: These cysts are mostly benign and commonly occur in middle-aged women. They usually are located in the body or tail of the pancreas. Typically they are small and cause no symptoms although rarely they may cause abdominal pain.
  • Mucinous cyst adenomas: Thirty percent of these cysts contain cancer, and those that do not contain cancer are considered precancerous. They also commonly occur in middle-aged women and are usually located in the body or tail of the pancreas.
  • Intraductal papillary mucinous neoplasm (IPMN): These cysts have a high likelihood of being or becoming cancerous. At the time of diagnosis, there is a 45% to 65% chance of the cyst already being cancerous. These cysts are more common in middle-aged men and are more commonly located in the head of the pancreas. The cysts typically produce large amounts of mucous which sometimes can be seen draining out of the papilla of Vater at the time of endoscopic retrograde cholangio-pancreatography (ERCP), a test that visualizes the ampulla of Vater and the pancreatic duct. These cysts can cause abdominal pain, jaundice, and pancreatitis. Increased risk for cancer occurs with older age of the patient, presence of symptoms, involvement of the main pancreatic duct, dilation of the main pancreatic duct over 10 mm, the presence of nodules in the wall of the duodenum, and size over 3 cm for side-branch IPMN.
  • Solid pseudopapillary tumor of the pancreas: These are rare tumors that have both solid and cystic components and are found mainly in young Asian and black women. They may reach a large size and can become malignant. Prognosis is excellent after complete surgical resection of these tumors.

How are pancreatic cysts diagnosed?


Endoscopic ultrasound (EUS) is becoming increasingly useful in determining whether a pancreatic cyst is likely to be benign, precancerous, or cancerous. During endoscopic ultrasound, an endoscope with a small ultrasound transducer at its tip is inserted into the mouth and is passed through the esophagus and stomach into the duodenum. From this location, which is very close to the pancreas, liver, and gallbladder, accurate and detailed images can be obtained of the liver, pancreas and the gallbladder.





What is the treatment for pancreatic cysts?



Very small cysts can be followed to detect an increase in size that may indicate cancer or an increased risk of developing cancer. Management decisions must be individualized for each patient after discussions with a doctor familiar with the patient's health status. The following are examples of how a doctor might manage pancreatic cysts.

  2. Pancreatic cysts larger than 3 cm can be studied with endoscopic ultrasound and fine needle aspiration. If fluid cytology, CEA measurements or analysis of DNA suggest cancerous or precancerous changes, the patients can be evaluated for pancreatic surgery.
Medically Reviewed on 9/4/2018


UptoDate. Classification of Pancreatic Cysts.

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