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Pancreas

Cysts

Pseudocysts

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 24 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Not a true cyst because no epithelial lining
● Painful, localized collections of pancreatic secretions that develop after pancreatitis (acute or chronic), trauma, ductal calculi, obstructive neoplasms
● Complications: abscess, erosion into blood vessels and hemorrhage of splenic artery, infection (J Med Case Rep 2007 Oct 29;1:116), perforation into a hollow viscus

Treatment
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● Excise small pseudocysts in body/tail, drain pseudocysts in head

Gross description
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● 85% solitary, usually unilocular, in/near pancreas
● Thick, irregular wall, ragged inner surface, cloudy intraluminal contents

Gross images
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Multiseptated lesion filled with fluid


Encapsulated cystic lesion with yellow-green material


Resembling cystic neoplasm

Micro description
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● No epithelial lining, cyst arises from drainage of pancreatic secretions from damaged ducts into interstitial tissue, which becomes walled off by fibrous tissue
● Cyst wall contains histiocytes, giant cells, granulation tissue, rarely eosinophils
● Cyst may communicate with ductal system
● Fluid has high amylase content

Micro images
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Patient with chronic pancreatitis and pseudocyst; cyst lacks epithelial lining, wall contains dense collagen, chronic inflammatory cells and fat

 
No epithelial lining is present


Cyst contains multiple lipid droplets (Sudan Black+) and cholesterol clefts


Pseudocyst of ectopic pancreas in duodenum

Differential diagnosis
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● Pancreatic neoplasm, particularly if multiloculated
● Sterile abscess with liquefactive necrosis
● Serous cystadenoma with subtotal cystic degeneration: has glycogen-rich epithelial lining and prominent subepithelial capillaries (Am J Surg Pathol 2012;36:726)

End of Pancreas > Cysts > Pseudocysts

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