Simple mucinous cysts of the pancreas: Clinical and imaging findings - Case series and systematic review of the literature

Purpose: To present the clinical and imaging features of simple mucinous cysts (SMCs) of the pancreas through a case series analysis and a systematic review of the literature. Methods: A literature search was conducted in MEDLINE, Scopus, and Embase databases on July 1, 2025. 72 cases from 18 articles were selected, and 4 cases from the author's institution were included. Two radiologists evaluated the demographic, clinical, and radiological data. Results: There were 49 women (64.5 %) and 27 men (35.5 %), with a mean age of 63 years (standard deviation, 7 years). Patients were asymptomatic in 50.9 % of cases. No dysplasia was found at pathology in 87 % of cases; high-grade dysplasia or invasive carcinoma was found in 9.3 % of cases. Lesions were in the pancreatic head in 34.2 % of cases. The mean lesion size was 44.6 mm (SD, 37.1 mm). Most lesions were unilocular (65.8 %). Main pancreatic duct dilatation was absent in most cases (78.4 %). Solid components were mainly absent (89.1 %). The most common preoperative diagnoses were branch-duct intraductal papillary mucinous neoplasm and mucinous cystic neoplasm. In most cases, SMCs demonstrated progressive size increase during imaging surveillance. Conclusions: SMC usually presents a solitary cystic lesion not communicating with the main pancreatic duct. Even though this is a challenging diagnosis, an SMC should be considered when a pancreatic cyst larger than 1 cm and consistent with a mucinous cystic neoplasm is detected in a man or in the pancreatic head.