**6. Pancreatic pseudocysts differential diagnosis**

Although PPCs are the most frequent cystic lesions, there are other malignant cystic lesions that can mimic the clinical manifestations of the PPCs. Malignant


### **Table 1.**

*Pan G. et al. classification of pancreatic pseudocysts.*

cystic lesions account for 10–15% of the pancreatic cysts [12]. It is well established, that imaging modalities alone can be misleading in diagnosing cystic malignancies due to the imaging similarities [13]. In general terms, the risk of potential malignancy in incidentally detected cysts is low [14]. The most common cystic malignancy is Branch Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) [15]. Predictive factors for malignancy are the size of the cyst (>3 cm), dilated pancreatic duct, and the solid component associated with the cyst. Multiple cysts and cyst enlargement over time are not correlated with the appearance of neoplasm [14].

The distinction is important in order to provide the optimal therapy for the patient. The differential diagnosis should include serous cystic tumors, mucinous cystic neoplasms, solid pseudopapillary neoplasms, and the recently known Intraductal papillary mucosa neoplasm (IPMNs). In the context of absence of history of pancreatitis, the physicians should suspect malignancy and further diagnostic modalities such as image-guided aspiration/biopsy should be performed. Magnetic resonance cholangiopancreatography (MRCP) can visualize possible communication between the main pancreatic duct and a cystic lesion noninvasively. In addition, endoscopic ultrasound can provide further structure information in greater detail and facilitate aspiration or biopsy of smaller lesions [16].
