الفهرس 
Pancreas ,Structure and FunconOnly 14 pages are availabe for public view
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Abstract
Pancreatic cysts are fluid-filled structures in and around the
pancreas.Pancreatic cysts include inflammatory lesions, lowgrade
neoplasms, and malignant neoplasms. Although possible etiologies of
pancreatic cysts are numerous, the most common are pseudocysts and
cystic tumors (David et al., 2010) .
The first step in evaluation is to differentiate pseudocysts from
cystic neoplasms, since inflammatory pseudocysts are the most common
lesion and are benign in nature. Once a pancreatic pseudocyst has been
excluded, attention should be focused on the differential diagnosis
among the types of cystic neoplasms. The most important diagnostic
strategy is to differentiate SCA from mucinous types including MCN and
IPMN, and this is due to the benign nature of SCA. Although serous
cystadenocarcinomas have been described, they are so rare that serous
cystic neoplasms should be managed as benign disease (Tanaka et al.,
2008) .
Mucinous lesions on the other hand are potentially or overtly
malignant lesions, and generally surgery is the treatment of choice.
Based on their location within the ductal system, IPMNs are classified as
main-duct or branch-duct type and several studies have suggested that the
latter have a more favorable prognosis (Carlos FC et al., 2008).
The combination of clinical history and characteristics along with
imaging findings may increase the diagnostic accuracy in the
discrimination of pancreatic cysts. Because the results of conventional
imaging and endosonography are not completely satisfactory in
distinguishing different lesions and in estimating their malignant
potential, EUS-guided cyst fluid analysis of cytology, chemistry, and tumor markers has been increasingly performed to provide additional
information (Hyoung-Chul et al., 2008) .
The Pancreatic Cyst DNA Analysis (PANDA) study was a very
important prospective study that took place in many centers across the
United States. The study authors found that K-ras mutation was
relatively specific for a mucinous cyst, with a specificity rate of more
than 90% (William et al., 2009).
The endoscopic and minimally invasive therapeutic procedures for
the drainage of pancreatic pseudocysts are superior to open surgical
techniques with respect to their success rates, morbidity, and mortality,
but they cannot always be performed .
In making treatment decisions, it is important to recall that 50% of
pancreatic pseudocysts do not require any intervention and can be
successfully managed by a wait-and-watch approach (David J.C. et al.,
2010).
Laparoscopic and endoscopic drainage have comparable success
rates, while that of transcutaneous drainage is somewhat worse. Thus,
the choice of technique depends very heavily on the experience of the
treatment center. Pancreatic pseudocysts require treatment when they
cause symptoms, produce complications, or have reached a size
exceeding 5 cm and do not regress after 6 weeks of observation. In the
last named situation, treatment is indicated because complications can
otherwise be expected (Markus et al., 2009) .
All MCNs are thought to progress ultimately to malignancy, and
most middle-aged patients with mucinous cystadenomas may develop
overt malignancies during their lives (Tanaka et al., 2008) .2aW