Learning more about pancreatic cysts

As part of the Cyst Imaging Surveillance and Treatment (CIST) Center at Massachusetts General Hospital, our physicians see a large number of patients with a variety of pancreatic cysts.

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Distinguishing between different types of cystic lesionsMGH clinicians see a large number of patients each year with a variety of cystic lesions of the pancreas. Using imaging, the patient’s history and results of fluid aspiration, the type of cyst can usually be determined. The management of cysts is dependent upon the type of cyst and risk of malignancy. Learn more at the Digestive Healthcare Center

  • Intraductal papillary mucinous neoplasms (IPMNs) are the most common type of cystic neoplasm and have a risk of malignant degeneration over time. These cysts occur in more than 2% of American adults. IPMNs are classified by whether they arise from side branches or the main pancreatic duct. Clinical tests, including magnetic resonance cholangiopancreatograpy (MRCP), endoscopic ultrasound (EUS), cytology and cyst fluid analysis are used to select high-risk patients for surgical intervention. Collaboration between specialties and various disciplines involved in the understanding of cystic lesions of the pancreas is a major strength of the MGH CIST Center.

  • Mucinous cystic neoplasms (MCNs) are usually seen in young or middle women and the lesion is often located in the tail of the pancreas.

  • Serous cystadenoma are a relatively common type of cystic lesion. Although the solitary lesions can grow over time, the lesion is almost always benign.

Typical IPMN

  Serous cystadenoma
A typical example of a malignant main duct IPMN. Note the presence of malignant nodules in the wall of the duct. The nodules represent early malignancy arising from the epithelium of the IPMN.   A typical example of a serous cystadenoma


MCN as seen by CT  
An MCN in the tail of the pancreas, as seen with a CT scan   This video for medical professionals illustrates the diagnosis of pancreatic cystic neoplasms. Watch video








Ongoing research projects in the CIST Center

We are using advanced endoscopic techniques for the detection of early pancreatic malignancy arising from cystic lesions of the pancreas. Endoscopic ultrasound is used to guide fine needle aspiration and optical coherence tomography (OCT) imaging. A variety of cyst fluid markers are used to enhance the diagnostic accuracy of EUS imaging alone. We have examined the accuracy of CEA and cytology in the diagnosis of mucinous cystic lesions. Currently we are investigating new molecular markers. OCT imaging is performed using a novel catheter placed within a EUS needle and guided into a cystic lesion.

Other research projects include the following:

  • Retrospective study of pancreatic cyst fluid analysis in the differentiation of the four tissue types of IPMN
  • Prospective study of pancreatic cyst fluid microRNA: optimal collection and storage conditions
  • Optical coherence tomography of pancreatic cystic lesions
  • Detection of tissue tumor suppression gene mutations in pancreatic cystic lesions


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