Pancreas Cyst Clinic

About This Program

The Pancreas Cyst Clinic, a collaboration between the Digestive Healthcare Center, the Mass General Cancer Center and Newton-Wellesley Hospital, provides imaging services as well as treatment and monitoring of patients with pancreatic cystic lesions. Our clinicians offer patients a comprehensive and personalized history and physical examination. The evaluation includes a review of previous imaging results, cyst fluid analysis and risk factors for malignancy. Computed tomography and Magnetic resonance imagery scans are submitted for interpretation by specialists in the Mass General Department of Imaging.

Imaging

Magnetic resonance cholangiopancreatography

At Mass General and Newton-Wellesley Hospital, the preferred imaging test for pancreatic cystic lesions is magnetic resonance cholangiopancreatography (MRCP). Advanced MRI techniques are used to obtained high resolution, 3-dimensional images of the pancreas and cystic lesions. The images are used to calculate the precise diameters and volume of cystic lesions. Growth of the cystic lesions is calculated over time. The presence of abnormal growths in the wall of cysts (mural nodules) is noted, along with other findings such as dilated pancreatic ducts.

Endoscopic ultrasound

Endoscopic ultrasound (EUS) provides high-resolution images of pancreatic cystic lesions and guides fine needle aspiration. At Mass General and Newton-Wellesley Hospital, EUS has proven to be a strong tool for the evaluation of mural nodules and masses, and collection of cyst fluid. One of the most accurate markers for mucinous cysts, carcinoembryonic antigen (CEA), was developed at Mass General in a large multi-center trial. Other markers of mucinous cysts and malignancy based on DNA mutations are being pioneered in the Mass General Molecular Pathology Laboratory.

In selected patients, endoscopic ultrasound is used to aspirate pancreatic cysts. The aspirated fluid is analyzed for cytology (imaging of cells), tumor markers (CEA), and DNA markers of malignancy. KRAS is the most commonly used DNA marker and helps define the presence of a mucinous cyst. Advanced DNA analysis is performed in the Mass General Molecular Pathology Laboratory, which has established itself as an important new resource for diagnostic studies in genetic mutations.

Surgical Options

The surgical management of pancreatic cysts was pioneered by Dr. Andrew Warshaw at Mass General nearly 40 years ago. Surgical excision of cysts requires that an entire segment of the pancreas be resected and not just the cyst alone. The type of resection is dependent upon the location of the cyst. A resection of a cyst in the head of the pancreas involves a Whipple resection.

Mass General performs more Whipple resections than any other hospital in New England. Cysts located in the body and tail of the pancreas require a distal pancreatectomy, which is often done laparoscopically (or robotically). For cysts located in the neck or proximal body of the pancreas, a middle pancreatectomy, an operation that was pioneered at Mass General, can be done. Compared to the alternative of a distal pancreatectomy, a middle pancreatectomy is much less likely to lead to diabetes or pancreatic exocrine insufficiency. 

Surgical resection margins are evaluated by an expert pancreatic pathologist at the time of the operation to ensure that no concerning disease is left behind. Resected lesions are carefully analyzed by pathologists to determine the type of cyst, the presence of malignancy and the stage of malignancy. One of the major developments in the classification of IPMN has been lead by a Mass General pathologist, Dr. Mari Mino-Kenudson. There are four tissue types of IPMN and the type of IPMN has a major impact on the behavior and aggressiveness of malignant IPMNs.