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Hépato-Gastro & Oncologie Digestive

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Pancreatic cystic neoplasms, indications of resection or follow-up Volume 26, issue 8, Octobre 2019

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Author
Hôpital Beaujon, Service de pancréatologie et gastroentérologie, Université de Paris, Centre de Référence des Maladies Rares du Pancréas, PaRaDis, Centre de Référence Européen d’Excellence pour les tumeurs neuroendocriniennes, 100 boulevard du Général Leclerc 92110 Clichy
* Correspondance

The practice of every gastroenterologist is daily punctuated by the management of patients with pancreatic cystic lesions (PCL). The discovery is usually fortuitous and the lesions in majority are small (less than 10 mm). The prevalence of PCL in the general population of adults is probably > 40%. The follow up and the indications of surgery are the two main issues for these patients. Two types of PCL are precancerous lesions, IPMN and mucinous cystadenomas, with a real risk of pancreatic adenocarcinoma and others cystic lesions have a potential for malignancy with risk of metastases such as pseudopapillary and solid tumors or cystic neuroendocrine tumors.

The follow-up protocol, recommended by international experts, is highly debated because it is expensive, potentially invasive (in case of repeated use of endoscopic ultrasound requiring general anesthesia) and not perfect (development of cancer between two surveillance examinations). Only a very small portion of these patients will develop aggressive and potentially invasive lesions. However, the lack of specific diagnostic tools for the grade of dysplasia and the mortality rate of pancreatic cancer leads European experts to recommend regular monitoring.

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