Özet:

Background and aims: The identification frequency of pancreatic cystic lesions are increasing day by day due to the widespread use of cross-sectional imaging methods such as computed tomography and magnetic resonance imaging. Pancreatic cystic lesions are simply divided into two main classes: non-neoplastic (e.g. pseudocysts) and neoplastic cysts. Managing the treatment of pancreatic cystic lesions is difficult for the clinic; therefore, in order to make differential diagnosis; medical history, clinical, laboratory, radiological imaging, endoscopic ultrasonography, evaluation of cyst fluid analysis and cytopathology data obtained with endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration is important. The objective of this study was to investigate clinical, laboratory, radiological, endoscopic ultrasound and pathological examinations of the pancreatic cystic neoplasms by comparing the diagnostic contribution with pseudocysts. Materials and Method: 30 patients who underwent surgical operation and were diagnosed pathologic "neoplastic cyst" of pancreatic cystic lesions with endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration biopsy evaluation in the gastroenterology clinic of the 9th September Medical Faculty between July 2009 and August 2017 with 46 patients who history of acute pancreatitis with a diagnosis of "pseudocyst" were included in the endoscopic ultrasonography reports after evaluation of endoscopic ultrasonography/endoscopic ultrasonography-fine needle aspiration biopsy with pancreatic cystic lesions, were included in the study. The demographic characteristics of the patients, clinical features, laboratory data, radiological/endoscopic ultrasonography image reports and pathological examination results were investigated retrospectively. Results: Surgical pathology results of 30 patients for pancreatic cystic lesions were intraductal papillary mucinous neoplasm in 15 patients (%50), cystic adenocarcinoma in 6 patients (%13), Solid pseudopapillary neoplasm in 4 patients (%13.3), mucinous cystic neoplasm in 3 patients (10%) and serous cystic neoplasm in 2 patients (%6.7). In the endoscopic ultrasonography; when the morphological characteristics of the pancreas and cysts are examined; 2 patients (%6. 7) in the neoplastic cyst group had chronic pancreatitis, 6 patients (%20) had expansion in main pancreatic duct, 2 patients (%6.7) had enlarged in the side branch pancreatic duct, 6 patients (%20) had cysts were associated with the pancreatic duct, 9 patients (%30) had septation, 5 patients (% 16.7) had lobularity, 5 patients (% 16.7) had calcification, 4 patients (%13.3) had thick of the cyst wall. As for in the pseudocyst group; 1 patient (%2.2) had septation and 1 patient (%2.2) had lobularity. In cyst fluid analysis with endoscopic ultrasonography-fine needle aspiration biopsy: in the cyst analysis of the neoplastic cyst group average amylase was 28808.8±60961.01 U/L and average Carcinoembryonic antigen value was 1055.29±1548. 14 ng/mL; in the cyst analysis of the pseudocyst group average amylase value was 28246.13±29858.56 U/L and average carcinoembryonic antigen value was 7.31±10.02 ng/mL. Endoscopic ultrasonography diagnosed 13 (43.3%) of the neoplastic cysts correctly. In mucinous cysts; when we add the diagnostic discrimination of endoscopic ultrasonography to any of the endoscopic ultrasonography-fine needle aspiration biopsyfindings (cytopathology, mucin, string sign and Carcinoembryonic antigen > 192 ng/mL) or all of them positive, the diagnostic sensitivity reaches up to 88.9%. Conclusion: In the diagnosis of neoplastic cysts of the pancreas; endoscopic ultrasonography and endoscopic ultrasonography-fine needle aspiration biopsyare the method with the highest diagnostic sensitivity. However, up to 15% is not sufficient to distinguish neoplastic/benign cyst. Its use with radiological methods increases diagnostic accuracy. Serum cancer antigen19-9 levels in diabetic patients with pancreatic cysts may be helpful in diagnosing neoplastic cysts.

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