Remedy Publications LLC., | http://clinicsinoncology.com/ Clinics in Oncology 2019 | Volume 4 | Article 1656 1 Pancreatic Incidentalomas: Asymptomatic often Malignant Lesions OPEN ACCESS *Correspondence: Ugo Cioff, Department of Surgery, University of Milan, Via F Sforza 35, Milano 20122, Italy, Tel: +39- 3388804789; E-mail: ugocioff5@gmail.com Received Date: 13 Aug 2019 Accepted Date: 28 Aug 2019 Published Date: 05 Sep 2019 Citation: Burati M, Chiarelli M, Terragni S, Molteni A, Cioff G, De Simone M, et al. Pancreatic Incidentalomas: Asymptomatic often Malignant Lesions. Clin Oncol. 2019; 4: 1656. Copyright © 2019 Ugo Cioff. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Published: 05 Sep, 2019 Editorial Te term incidentalomas means a non-symptomatic lesion, detected during imaging or biochemical studies for unrelated causes. Te constant improving of high-quality imaging has increased the number of asymptomatic solid or cystic masses that can be detected. Te most common incidentalomas described in literature are located in the adrenal gland, thyroid, liver, heart and prostate. Teir prevalence and their management are well described and largely accepted [1]. Among these, Pancreatic Incidentalomas (PI) are becoming more and more common, but data regarding their prevalence and treatment strategy are still poor and consequently some aspects of their management are still debated. According to the current literature, PI prevalence is 10% in the adult population, reaching 30% in the elderly [2]. Tey are usually detected during workups for non-pancreatic symptoms or follow- ups for other malignant pathologies. The biological nature of PIs is represented by a wide range of neoplasms: Pancreatic Ductal Adenocarcinoma (PDAC), Intraductal Papillary Mucinous Neoplasms (IPMN), Mucinous Cystic Neoplasms (MCN), Serous Cystadenomas (SCA), Non-Functional Neuroendocrine Tumors (NET), Acinar Cell Carcinoma (ACC) and Solid Pseudopapillary Neoplasm (SPPN) [3,4]. In a case series published by Lahat et al. [1] PDAC was the most common finding among PIs, followed by IPMN and MCN. Although they present with no symptoms related, these lesions can be premalignant or even already malignant. PIs could be categorized into solid and cystic lesions. Cystic PIs frequently show a benign or premalignant nature while solid PIs are usually considered malignant masses. According to recent studies, size >20 mm and biliary dilatation are related to malignancy and, when simultaneously present, the frequency of malignancy is above 90% [5]. It is important to underline that pancreatic adenocarcinomas located in the head of the gland are more frequently symptomatic than body and tail neoplasms. They are responsible for jaundice, main pancreatic duct dilatation and its related symptoms such as endocrine and exocrine pancreatic insufficiency. The detection of asymptomatic lesions represents also a significant issue in those individuals with strong family history of PDAC. These are patients with an inherited predisposition, like Peutz-Jeghers syndrome, family breast and ovarian cancer and hereditary nonpolyposis colorectal cancer, who could benefit a screening program. Canto et al. [6] recently demonstrated that screening programs for these asymptomatic patients could easily detect small pancreatic lesions. In these cases MRI and endoscopic ultrasonography detect PIs better than CT [6]. Since not all lesions have malignant potential, the operative strategy could be complex and surgeons must consider the risks and benefits of performing a potentially morbid operation for a possible benign condition [7]. It is well-known that surgical treatment for pancreatic lesions is characterized by high rate of mortality and morbidity. Mortality after a pancreaticoduodenectomy (PD) procedure is reported as 1% to 3% in high volume centers and up until 10% in smaller ones [8], while morbidity concerns about 30% to 40% of patients [9]. The most frequent sources of postoperative morbidity include postoperative hemorrhage, delayed gastric emptying, postoperative pancreatic fistula and intra-abdominal abscess [10]. Morena Burati 1 , Marco Chiarelli 1 , Sabina Terragni 1 , Alberto Molteni 1 , Gerardo Cioff 2 , Matilde De Simone 3 , Pierfrancesco Leone 3 , and Ugo Cioffi 3* 1 Department of Surgery, Ospedale Alessandro Manzoni, Italy 2 Department of Sciences and Technologies, University of Sannio, Italy 3 Department of Surgery, University of Milan, Italy