The Role of Endoscopic Ultrasound in the Management and Diagnosis of Pancreatic Cystic Tumors

Background: Cystic tumors of the pancreas are rare neoplasms, increasingly discovered incidentally due in part to improvements in pancreatic imaging techniques (ultrasound, multidetector CT scan (Computed Tomography scan), Magnetic Resonance Imaging (MRI)) and enhanced understanding of these lesions' characteristics. They encompass serous cystadenomas (SC), mucinous cystadenomas (MC), intraductal papillary mucinous neoplasms (IPMN), and solid pseudopapillary tumors (SPPT).

Method: This is a single-center study conducted at the EFD-HGE Unit (functional digestive exploration -hepato-gastroenterology unit) of Ibn Sina Hospital in Rabat, from September 2015 to May 2024, including all patients with pancreatic cystic tumors. Pancreatic pseudocysts were excluded from the study. Epidemiological, clinical, biological, and endoscopic ultrasound data were collected from Endoscopic Ultrasound registries.

Results: Out of 696 biliopancreatic endoscopic ultrasounds performed, 57 patients were included, representing a prevalence of 8.18%. The mean age was 62.3 years (range 29-82 years) with a clear female predominance (M: 22, F: 35) (Sex Ratio = 0.62). Discovery circumstances were incidental in 23 cases (40.3%), epigastric pain in 18 cases (31.57%), acute pancreatitis in 6 cases (10.5%), jaundice in 5 cases (8.7%), and abdominal pain in 5 cases (8.7%). Biochemically, cholestasis was found in 14 cases (24.5%), cytolytic enzymes were elevated in 7 cases (12.2%), and elevated Ca19-9 in 6 cases (10.52%). Endoscopic ultrasound delineated tumor location, number, and size: predominantly in the pancreatic head in 25 cases (43.8%), body in 15 cases (26.3%), tail in 10 cases (17.5%), multifocal in 7 cases (12.28%), with an average tumor size of 24.5 mm (range2,5 -76,5 mm). Endoscopic ultrasound appearance and cystic fluid analysis favored IPMN in 77.1% (n=44), mucinous cystadenoma in 8.7% (n=5), SPT in 7% (n=4), serous cystadenoma in 5.26% (n=3), and adenocarcinoma in one case.

Conclusion: Pancreatic cystic tumors are rare and often incidentally discovered. They predominantly occur in the pancreatic head, with IPMN being the most common, followed by mucinous cystadenomas, while serous cystadenomas and SPPTs are less frequent