Surgical treatment of incidentally identified pancreatic masses

Incidentally discovered abdominal masses (incidentalomas) are increasingly being detected.1,2,3,4,5 Common incidentalomas occur within the liver, kidney and adrenal glands. In a Mayo Clinic study of computed colonography, 108 (41%) of 264 patients had extracolonic findings,6 which included 30 intra-abdominal masses (2 were malignant renal tumours). Incidental adrenal masses are found on 0.4% to 4.9% of CT scans, and it is well established that these lesions can be followed with serial imaging if they are not large, hormonally active or overtly malignant.1,3,4 The majority of renal cell carcinomas are now identified incidentally, and this incidental discovery appears to be altering the natural history of the disease.2,7,8 Incidentally discovered hepatic lesions have also been described and have been found to be of little clinical relevance in 83% of cases.5 There has also been an increase in the occurrence of unusual tumours of the pancreas identified incidentally in asymptomatic patients. These tumours include serous cystadenomas, mucinous cystadenomas, mucinous cystadenocarcinomas, nonfunctional neuroendocrine tumours, papillary cystic and solid tumours, and intraductal papillary mucinous neoplasms.9,10,11,12,13,14 It is postulated that this increase is secondary to the widespread availability and use of abdominal imaging.9 Apart from serous cystadenomas, all of these lesions are either malignant or have malignant potential.10,15,16,17 A description of the clinical features of asymptomatic patients with pancreatic incidentalomas and their management is lacking. In this study, we reviewed a single surgeon's 13-year experience of pancreatic incidentalomas to determine the clinical features and assess the accuracy of preoperative radiologic diagnosis compared to the final pathological diagnosis of incidental pancreatic masses in these asymptomatic patients.