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. 1993 Jan;217(1):41–47. doi: 10.1097/00000658-199301000-00008

Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma.

K B Lewandrowski 1, J F Southern 1, M R Pins 1, C C Compton 1, A L Warshaw 1
PMCID: PMC1242732  PMID: 8424699

Abstract

Pancreatic cystic lesions include inflammatory pseudocysts, benign serous tumors, and mucinous neoplasms, some of which are malignant. Clinical and radiologic indices are often inadequate to discriminate reliably among these possibilities. In an attempt to develop new preoperative diagnostic criteria to assist in decisions regarding therapy, the authors have performed cyst fluid analysis for tumor markers (carcinoembryonic antigen: CEA, CA 125, and CA 19.9), amylase content, amylase isoenzymes, relative viscosity, and cytology on 26 pancreatic cysts. The cases included nine pseudocysts, five serous cystadenomas, 4 mucinous cystic neoplasms, 7 mucinous cystadenocarcinomas, and one mucinous ductal adenocarcinoma with cystic degeneration. Carcinoembryonic antigen levels were high (> 367) in all benign and malignant mucinous cysts, but were low (< 23) in the pseudocysts and benign serous cystadenomas, an indication that CEA discriminates between mucinous and nonmucinous cysts (p < 0.0001). Values for CA 125 were high in all malignant cysts, low in pseudocysts, and variable in mucinous cystic neoplasms and serous cystadenomas. Levels of Ca 19.9 were nondiscriminatory. Cyst fluid amylase and lipase content were variable but were generally high in pseudocysts and low in cystic tumors. Amylase isoenzyme analysis was useful to differentiate pseudocysts from cystic tumors. Measurement of the relative viscosity in cyst fluid showed high (> serum viscosity) values in 89% of mucinous tumors and low values (< serum) in all pseudocysts and serous cystadenomas (p < 0.01). Cytologic analysis of cyst fluids was of limited value in differentiating pseudocysts from serous cystadenoma, but in seven of eight mucinous tumors provided useful diagnostic information and correctly classified three of five malignant tumors. The authors conclude that cyst fluid analysis can provide a preoperative classification of these diagnostically difficult lesions. The combination of viscosity, CEA, CA 125, and cytology can reliably distinguish malignant cystic tumors and potentially premalignant mucinous cystic neoplasms from pseudocysts and serous cystadenomas. Amylase content with isoenzyme analysis is useful to identify pseudocysts.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Compagno J., Oertel J. E. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol. 1978 Mar;69(3):289–298. doi: 10.1093/ajcp/69.1.289. [DOI] [PubMed] [Google Scholar]
  2. Compagno J., Oertel J. E. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol. 1978 Jun;69(6):573–580. doi: 10.1093/ajcp/69.6.573. [DOI] [PubMed] [Google Scholar]
  3. Jones E. C., Suen K. C., Grant D. R., Chan N. H. Fine-needle aspiration cytology of neoplastic cysts of the pancreas. Diagn Cytopathol. 1987 Sep;3(3):238–243. doi: 10.1002/dc.2840030313. [DOI] [PubMed] [Google Scholar]
  4. Lumsden A., Bradley E. L., 3rd Pseudocyst or cystic neoplasm? Differential diagnosis and initial management of cystic pancreatic lesions. Hepatogastroenterology. 1989 Dec;36(6):462–466. [PubMed] [Google Scholar]
  5. Nishida K., Shiga K., Kato K., Kunihiro K., Fujii T., Tomii T., Yamamoto H., Yamane E., Nishioka B., Yoshikawa T. Two cases of pancreatic cystadenocarcinoma with elevated CA 19-9 levels in the cystic fluid in comparison with two cases of pancreatic cystadenoma. Hepatogastroenterology. 1989 Dec;36(6):442–445. [PubMed] [Google Scholar]
  6. Pinto M. M., Meriano F. V. Diagnosis of cystic pancreatic lesions by cytologic examination and carcinoembryonic antigen and amylase assays of cyst contents. Acta Cytol. 1991 Jul-Aug;35(4):456–463. [PubMed] [Google Scholar]
  7. Sachs J. R., Deren J. J., Sohn M., Nusbaum M. Mucinous cystadenoma: pitfalls of differential diagnosis. Am J Gastroenterol. 1989 Jul;84(7):811–816. [PubMed] [Google Scholar]
  8. Schwerk W. B. Ultrasonically guided percutaneous puncture and analysis of aspirated material of cystic pancreatic lesions. Digestion. 1981;21(4):184–192. doi: 10.1159/000198561. [DOI] [PubMed] [Google Scholar]
  9. Shorten S. D., Hart W. R., Petras R. E. Microcystic adenomas (serous cystadenomas) of pancreas. A clinicopathologic investigation of eight cases with immunohistochemical and ultrastructural studies. Am J Surg Pathol. 1986 Jun;10(6):365–372. doi: 10.1097/00000478-198606000-00001. [DOI] [PubMed] [Google Scholar]
  10. Steinberg W. M., Gelfand R., Anderson K. K., Glenn J., Kurtzman S. H., Sindelar W. F., Toskes P. P. Comparison of the sensitivity and specificity of the CA19-9 and carcinoembryonic antigen assays in detecting cancer of the pancreas. Gastroenterology. 1986 Feb;90(2):343–349. doi: 10.1016/0016-5085(86)90930-3. [DOI] [PubMed] [Google Scholar]
  11. Tatsuta M., Iishi H., Ichii M., Noguchi S., Yamamoto R., Yamamura H., Okuda S. Values of carcinoembryonic antigen, elastase 1, and carbohydrate antigen determinant in aspirated pancreatic cystic fluid in the diagnosis of cysts of the pancreas. Cancer. 1986 May 1;57(9):1836–1839. doi: 10.1002/1097-0142(19860501)57:9<1836::aid-cncr2820570922>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  12. Warshaw A. L., Compton C. C., Lewandrowski K., Cardenosa G., Mueller P. R. Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg. 1990 Oct;212(4):432–445. doi: 10.1097/00000658-199010000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Warshaw A. L., Lee K. H. Aging changes of pancreatic isoamylases and the appearance of "old amylase" in the serum of patients with pancreatic pseudocysts. Gastroenterology. 1980 Dec;79(6):1246–1251. [PubMed] [Google Scholar]
  14. Warshaw A. L., Rattner D. W. Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria. Ann Surg. 1985 Dec;202(6):720–724. doi: 10.1097/00000658-198512000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Warshaw A. L., Rutledge P. L. Cystic tumors mistaken for pancreatic pseudocysts. Ann Surg. 1987 Apr;205(4):393–398. doi: 10.1097/00000658-198704000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Yu H. C., Shetty J. Mucinous cystic neoplasm of the pancreas with high carcinoembryonic antigen. Arch Pathol Lab Med. 1985 Apr;109(4):375–377. [PubMed] [Google Scholar]

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