Updates in the Management of Mucinous Cystic Neoplasms

Abstract As incidentally discovered pancreatic cysts become increasingly common on cross-sectional imaging, understanding their diagnosis and management has grown in clinical importance. Pancreatic mucinous cystic neoplasms (MCNs) are mucin-producing cystic lesions characterized by pathognomonic ovarian-like stroma, almost exclusively identified in middle-aged women. While historically considered benign tumors with inherent malignant potential, the management of MCNs is currently evolving as recent data clarify the risks of high-grade dysplasia and invasive carcinoma. This review integrates current literature on MCN diagnosis and treatment, emphasizing the utility of cross-sectional imaging and endoscopic ultrasound. The surgical decision-making process is increasingly influenced by the risk of postoperative morbidity and long-term complications, such as diabetes. Furthermore, this review explores the potential of next-generation sequencing, cyst fluid proteomics, and confocal laser endomicroscopy to improve preoperative diagnostic accuracy. Ultimately, a shift toward personalized management is anticipated, utilizing multi-center trial data and molecular diagnostics to better distinguish between patients requiring definitive resection and those suitable for conservative surveillance.