Proliferative pancreatic cysts: pathogenesis and treatment options.

Proliferative pancreatic cysts are subdivided into microcystic and mucinous cystadenomas. These rare, slow-growing, multilocular lesions usually remain localized for long periods of time, therefore frequently becoming rather sizeable before becoming symptomatic. Patients present with intermittent abdominal or back pain, nausea and vomiting, early satiety, and a palpable mass without a history of trauma or alcoholism. Computed tomographic scanning is the most useful laboratory test. The lesions are more often found in women, with the microcystic adenomas usually located in the head of the pancreas and the mucinous lesions in the pancreatic body or tail. At surgery, if it is at all possible, the lesions should be completely removed, even if it means performance of a Whipple procedure. This is particularly important for mucinous cysts because of their potential for malignant degeneration. Internal drainage or marsupialization procedures should not be done in these patients. The long-term results are excellent if the entire lesion is removed.