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Pancreatic cysts are fluid-filled sacs that form in or on the pancreas. They are often discovered by chance or incidentally, during imaging for unrelated conditions. Many of these cysts are benign (noncancerous), although others have the potential to become malignant (cancerous).

Experts at ���ϸ����� Langone Health manage the full range of pancreatic cysts:

• pseudocysts
• intraductal papillary mucinous neoplasms
• mucinous cystic neoplasms
• serous cystic neoplasms
• cystic neuroendocrine tumors

Pseudocysts

Pseudocysts are not true cysts because they lack a lining of cells. They are fluid collections that form after an episode of acute or chronic pancreatitis, abdominal trauma, or blockage in the pancreatic duct. They are more common than any true pancreatic cyst. Although pseudocysts themselves are not cancerous, they can sometimes cause symptoms like abdominal pain and may require drainage if they grow large or become infected.

Intraductal Papillary Mucinous Neoplasms

Intraductal papillary mucinous neoplasms are one of the most common tumors in the pancreas that form cysts. These growths can be noncancerous or cancerous and are classified based on their location in the pancreas, which include the following:

• the main duct, which is the channel that drains digestive enzymes from the pancreas
• the branch ducts, which are the smaller side branches that connect to the main duct
• both the main and branch ducts, in which case the neoplasms are called mixed type

Main duct intraductal papillary mucinous neoplasms have a higher risk of becoming cancerous. Branch duct neoplasms are lower risk but still require careful evaluation and monitoring.

Symptoms of both main and branch duct cysts may include abdominal pain, jaundice, pancreatitis, or weight loss. However, many patients have no symptoms.

Our doctors provide a thorough assessment of the size, location, and risk features of these pancreatic cysts. Risk features include the presence of mural nodules, which are solid growths on the cyst wall that may signal a higher cancer risk, or widening of the main duct of the pancreas, which may be due to tumor growth.

High-risk intraductal papillary mucinous neoplasms often require surgery to prevent progression to pancreatic cancer. Low-risk intraductal papillary mucinous neoplasms may undergo surveillance.

Mucinous Cystic Neoplasms

Mucinous cystic neoplasms are pancreatic cysts that mostly affect women and are typically located in the middle section or in the tail of the pancreas. These cysts are lined with mucin-producing cells—cells that make mucus—and can progress to pancreatic cancer.

Mucinous cystic neoplasms are often solitary and do not arise within the pancreatic duct system, distinguishing them from intraductal papillary mucinous neoplasms. Symptoms include abdominal pain or a palpable mass, meaning that the cyst can be felt, but many are asymptomatic and are found incidentally.

Serous Cystic Neoplasms

Serous cystic neoplasms are noncancerous and tend to be asymptomatic and discovered incidentally. They are made up of many small cysts and have a honeycomb-like appearance on imaging. They also have a very low risk of malignancy. Serous cystic neoplasms are more common in women and can occur anywhere in the pancreas. If symptoms— including abdominal pain, bloating, or feeling full after eating a small amount of food— occur, they are likely caused by the cyst’s size and the pressure it places on the pancreas or nearby organs.

Serous cystic neoplasms may require surveillance with periodic imaging. Surgery may be recommended if they become large enough to cause symptoms.

Cystic Neuroendocrine Tumors

Cystic neuroendocrine tumors are rare and arise from the neuroendocrine cells of the pancreas. These specialized cells help regulate body functions by receiving signals from the nervous system and releasing hormones into the bloodstream.

Cystic neuroendocrine tumors can be functional, meaning they produce hormones, or nonfunctional, meaning they do not. Functional tumors may cause symptoms such as low blood sugar, flushing, or diarrhea, depending on the hormones produced. Nonfunctional tumors may cause abdominal pain and jaundice once they are large enough to press on the pancreas and nearby organs.

These cysts are often identified through imaging and may require biopsy or other tests to determine whether cysts are producing hormones.

Treatment depends on the tumor’s size, behavior, and whether it is functional. Doctors at our cyst surveillance program may monitor small, nonfunctional cystic neuroendocrine tumors with imaging and clinical follow-up. Larger or functional cysts may require surgery.