Ms. Wang was recently found to have a cyst in her pancreas by ultrasound during a routine physical examination in her unit, but she had no symptoms and no previous history of pancreatic diseases such as pancreatitis. Now that we are all more health conscious, it is inevitable that we will be a bit scared and nervous when “pancreatic cysts” are found in units or individual medical checkups, feeling that it must be bad to have multiple cysts. Ms. Wang is a bit overwhelmed by what to do with this “pancreatic cyst”, she won’t have to undergo surgery, right? What is a “pancreatic cyst” Medically, a cyst is a closed “blister”, like a water-filled balloon. The shell of a cyst is a fibrous cyst wall made up of layers of cells with secretory functions, and the cyst cavity is filled with a clear, colorless or yellowish, sterile, protein-rich fluid called cyst fluid. Cysts can occur in various tissues throughout the body, most commonly in the liver, kidneys, and ovaries, and if the cyst grows in the pancreas it is called a pancreatic cyst. However, ultrasound reveals so-called “pancreatic cysts”, which is an imaging diagnosis and cannot accurately determine whether they are “benign” or “malignant”. It is more appropriate to call them “cystic lesions” of the pancreas or “cystic occupations” of the pancreas because they can range from completely benign to malignant cystic adenocarcinoma, which is exactly what people are worried about. What are the common “pancreatic cysts”? According to people’s concerns, cystic lesions of the pancreas can be divided into two categories: non-tumor and tumor, the latter also known as cystic tumors of the pancreas, some of which secrete mucus and some of which do not. “As the name implies, these two types of cystic lesions are not related to tumors and are “good people”, and can be divided into true and pseudocysts according to the composition of the cyst wall. Among them, pseudocysts are mostly secondary to pancreatitis, with a previous history of pancreatitis or pancreatic trauma, and there are no epithelial cells lining the cyst wall, so they are called pseudocysts, which account for more than 80% of all pancreatic cysts. In general, if the patient has a history of pancreatitis, it is easier for the doctor to diagnose pseudocysts, but many patients do not even know that they have a history of pancreatitis. True cysts of the pancreas are less common (epithelial cells on the wall of the cyst) and can be formed due to congenital, extra-pancreatic ductal compression, pancreatic duct stones, inflammatory stenosis and other factors. There are three common types of cystic tumors: plasmacytic cystic tumors, mucinous cystic tumors and intraductal papillary mucinous cystadenomas. Cystic tumors of the pancreas account for about 10% to 15% of cystic lesions of the pancreas. Benign tumors among cystic tumors of the pancreas also have the potential to become malignant, especially mucinous cystadenomas. For malignant or junctional cystic adenomas, surgical resection is required. What should I do if I find a “pancreatic cyst”? In fact, the main concern is whether the cyst is harmful or not, so the main task is to determine the nature of the cyst. Although the percentage of “pancreatic cysts” found accidentally during physical examinations that are eventually diagnosed as malignant tumors is not high, the nature of “pancreatic cysts” varies greatly from benign to malignant, so the discovery of “pancreatic cysts” should not be taken lightly. It is necessary to go to the pancreatic surgery department in time and ask an experienced pancreatic doctor to help analyze it. Doctors usually determine the nature of the “cyst” in general based on medical history (history of trauma or pancreatitis), symptoms (whether it causes pain, abdominal distension, etc.), imaging performance, and whether tumor markers are elevated. If a pancreatic cyst is detected by ultrasound, it is sometimes difficult to determine whether it is good or bad, and further MRI (enhancement) is required to obtain more detailed information to determine the nature of the cyst. It is necessary to do further MRI (enhancement) to get more detailed information to determine the nature of the cyst. Generally speaking, benign “pancreatic cysts” have the following characteristics: small (less than 1 cm), non-dilated pancreatic ducts, thin and uniform walls; pseudocysts often have a history of pancreatitis to aid in the diagnosis. In contrast, cystic tumors of the pancreas have the following characteristics: larger (>3 cm), thick cyst wall, irregular enhancement, pancreatic duct dilatation, and elevated tumor markers. If the cyst is considered to be a true cyst, it is not large and does not produce symptoms, so we do not need special treatment and it can be reviewed during physical examination; if it is a pseudocyst, surgery is not necessary for patients whose cyst is not very large, but it is better to review it regularly at the outpatient clinic, mainly to see if the cyst has recurrence or enlargement and if there is recurrence of pancreatitis. If it is considered to be a cystic tumor, it is generally believed that asymptomatic plasmacytoid cystic adenoma can be observed and followed up, and those with malignant potential should be resected.