Congenital cysts: Diagnosis, clinical impact, and management

Cystic lesions in the pancreas differ very much in origin. As a result of their improved recognition by modern imaging techniques and their successful and uncomplicated surgical treatment, they increasingly occupy gastroenterologists, surgeons, and pathologists, although their incidence is low. The identification and definition of pancreatic cysts has improved, however 5-10% of these lesions still remain undiagnosed prior to surgical intervention and assessment by the pathologist. The final diagnosis is not trivial or only of scientific interest, because of the major problem underlying all of these lesions, that of ruling out malignancy. The uncertainty related to cystic lesions for which all available preoperative diagnostic procedures have failed to definitely rule out the suspicion of cancer usually makes resection necessary. Of course, surgical or invasive treatment is obviously called for if symptoms or complications such as severe pain, intestinal obstruction or infection potentially leading to abscess formation or sepsis are present. These considerations relating to cystic lesions of the pancreas are also valid for congenital cysts. Only few of them can be diagnosed and specifically classified pre- or intraoperatively. Mechanical complications are not uncommon with these lesions. Regarding the decision whether to operate or to wait and watch, it is extremely valuable to know all about these lesions, their nature, and their potential for complications.