1.Dr. Ketul V. Shah1st year MCh G.I.Surgery residentV.S. Hospital, AhmedabadDiscussion; Dr Sanjay Nagral, Consultant GI surgeon,Mumbai.

2. Cystic lesion in Pancreas Task aheadI. Is the lesion from pancreas?II. Lesion is solid or cystic?III. Neoplastic v/s non-neoplastic?IV. SCA v/s MCN v/s IPMN?V. Management? 3. CASE HISTORY 45y/F c/o recurrent vomiting and loss of appetite - 6 mths. Vomitus contained food and occurred to 1 hour after meals & was non-bilious, non-projectile h/o diffuse abdominal pain significant weight loss ++ Anorexia ++ 4. There was no preceding history of any severe abdominal pain or jaundice No h/o lump in abdomen, abdominal distension Pt is not a k/c/o diabetes and no other positive medical or surgical history 5. ON EXAMINATION pallor +, No LNpathy P/A- soft, non tender, no palpable lump, no organomegaly. No ascitis. other systems normal. 6. INVESTIGATIONS DONE LFT wnl S. Amylase and Lipase were normal USG - A cystic lesion in the pancreatic head andneck region of about 7x5cm CECT - 73x60 mm cystic lesion in pancreatic head& neck region; cystic wall-3mm; MPD- normal; noperi-pancreatic LN or fluid. S. CA 19-9 wnl S. CEA - wnl 7. While approaching a cystic lesionswe need to know. Broad differential diagnosis Epidemiology of common lesions Clinical presentation Blood tests Imaging Histology 8. Broad D/Ds of Cystic PancreaticLesions1) Pseudocyst (75-80%)2) Common cystic pancreatic neoplasms Mucinous cystic neoplasm (10-45%) Serous cystic neoplasm (32-39%) IPMN (21-33%)3) Rare cystic pancreatic neoplasms Solid pseudopapillary tumor (