Pancreatic Pseudocyst

Definition

• Pancreatic or peripancreatic cystic lesion formed by resorption of fat necrosis

Diagnostic Criteria

• Located in or adjacent to the pancreas
• Lacks epithelial lining
• Wall may range from granulation tissue to fibrosis

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting: February 28, 2008
Last update: April 25, 2009

Supplemental studies

No diagnostically useful stains

Differential Diagnosis

• Lack of epithelial lining effectively separates it from other cystic lesions
  • Requires adequate sampling
• Adjacent stroma may be hypercellular, resembling the ovarian type stroma of mucinous cystic neoplasms
  • As above, lack of epithelial lining separates the two

Clinical

• Secondary to pancreatitis
  • Alcoholic
  • Biliary
  • Traumatic
• No association with neoplasm
• May erode into ducts or vessels

Lists

Cystic Pancreatic Lesions

• Acinar cell cystadenocarcinoma
• Acinar cell cystadenoma
• Enterogenous duplication cyst
• Epidermoid cyst in intrapancreatic accessory spleen
• Intraductal oncocytic papillary neoplasm
• Intraductal papillary mucinous neoplasm
• Islet cell / well differentiated neuroendocrine tumor (occasionally cystic)
• Lymphangioma
• Lymphoepithelial cyst
• Mucinous cystic neoplasm
• Paraduodenal wall cyst
• Pseudocyst
• Serous cystadenocarcinoma
• Serous oligocystic adenoma
• Serous microcystic adenoma
• Solid and cystic hamartoma
• Solid pseudopapillary neoplasm
• Squamoid cyst of pancreatic ducts
• von Hippel Lindau associated cystic lesions

Bibliography

• Adsay NV. Cystic lesions of the pancreas. Mod Pathol. 2007 Feb;20(Supp1):S71-S93).
• Solcia E, Capella C, Kloppel G . Tumors of the Pancreas, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 20, 1997.
• Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med. 2009 Mar;133(3):423-38.