Pancreatic cystic neoplasms are uncommon but increasingly detected due to advanced imaging techniques. Distinguishing benign from malignant cysts is crucial for appropriate treatment. Misdiagnosing a cystic neoplasm as a benign pseudocyst is a common mistake. Cystic fluid analysis, including endoscopic ultrasound-guided fine needle aspiration, can help determine the nature of the lesion. Surgical excision is the preferred treatment for cystic pancreatic neoplasms, even in asymptomatic patients, due to their potential malignancy. Pancreatic cystic neoplasms account for 10-15% of all pancreatic cystic lesions and 1% of all pancreatic neoplasms. With improved imaging, more cystic pancreatic lesions are found in asymptomatic patients, leading to complex therapeutic decisions. These neoplasms are often slow-growing and have a favorable prognosis with adequate surgery. However, once they develop local invasion and metastases, survival is poor. Common pancreatic cystic lesions include inflammatory pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous tumors (IPMT). CT scans can help differentiate pseudocysts from cystic neoplasms, with serous cystadenomas typically having more than six small cysts and mucinous neoplasms having fewer, larger cysts. CT can also detect calcifications, which help differentiate between serous and mucinous tumors. Dynamic CT with intravenous contrast is useful in differentiating serous cystadenomas from other cystic tumors. IPMTs are characterized by intraductal tumor growth and mucin hypersecretion, leading to cystic transformation of the pancreatic duct. Endoscopic findings may also be diagnostic, with a wide patent orifice filled with mucus. Imaging features on CT may be sufficient for a tentative diagnosis of mucinous cystic neoplasm and planning appropriate therapy. In some cases, ERCP may be used if CT findings are inconclusive. Cystic neoplasms rarely communicate with the pancreatic duct.Pancreatic cystic neoplasms are uncommon but increasingly detected due to advanced imaging techniques. Distinguishing benign from malignant cysts is crucial for appropriate treatment. Misdiagnosing a cystic neoplasm as a benign pseudocyst is a common mistake. Cystic fluid analysis, including endoscopic ultrasound-guided fine needle aspiration, can help determine the nature of the lesion. Surgical excision is the preferred treatment for cystic pancreatic neoplasms, even in asymptomatic patients, due to their potential malignancy. Pancreatic cystic neoplasms account for 10-15% of all pancreatic cystic lesions and 1% of all pancreatic neoplasms. With improved imaging, more cystic pancreatic lesions are found in asymptomatic patients, leading to complex therapeutic decisions. These neoplasms are often slow-growing and have a favorable prognosis with adequate surgery. However, once they develop local invasion and metastases, survival is poor. Common pancreatic cystic lesions include inflammatory pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous tumors (IPMT). CT scans can help differentiate pseudocysts from cystic neoplasms, with serous cystadenomas typically having more than six small cysts and mucinous neoplasms having fewer, larger cysts. CT can also detect calcifications, which help differentiate between serous and mucinous tumors. Dynamic CT with intravenous contrast is useful in differentiating serous cystadenomas from other cystic tumors. IPMTs are characterized by intraductal tumor growth and mucin hypersecretion, leading to cystic transformation of the pancreatic duct. Endoscopic findings may also be diagnostic, with a wide patent orifice filled with mucus. Imaging features on CT may be sufficient for a tentative diagnosis of mucinous cystic neoplasm and planning appropriate therapy. In some cases, ERCP may be used if CT findings are inconclusive. Cystic neoplasms rarely communicate with the pancreatic duct.