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Case Clinic:
Pancreatic cyst

Munich Re’s medical experts respond to challenging underwriting scenarios

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    May 2024

    This series presents individual medical cases that feature challenging conditions, uncommon diseases, or an unusual presentation of symptoms. Below, we summarize a case, explain our research and analysis, and suggest an underwriting recommendation. Munich Re’s team of global medical directors routinely conducts rigorous analyses of the latest medical advances so that primary insurers and society alike can benefit from evidence-informed risk assessments. It is our hope that exploring compelling cases will foster a greater understanding of medical research and awareness of new medical innovations and emerging risks while ultimately expanding insurability.

    Case: Pancreatic cyst

    The Munich Re medical team considered the insurability of a woman in her mid-60s who was evaluated in an emergency department over a year ago for left lower quadrant abdominal pain. CT imaging of the abdomen revealed diverticulitis as well as a 10-mm cystic structure in the body of the pancreas, with imaging features consistent with a serous cystadenoma. Her acute diverticulitis was treated appropriately, and her abdominal pain resolved. Subsequent to the interventions she felt well, without symptoms. The team asked, “What is the appropriate management for this pancreatic lesion? Is she insurable?”

    Munich Re medical's response

    • Serous cystic neoplasms (SCNs) or serous cystadenomas are non-mucinous lesions with characteristic findings on imaging. They are multi-cystic with a honeycomb appearance, sometimes described as a “bunch of grapes.” Most commonly seen in women over 60 years old, these lesions have a negligible risk for malignancy.
    •  Pancreatic cystic neoplasms are being detected more frequently and are mostly found incidentally due to the widespread use of abdominal imaging such as CT scans or MRIs. 
    • These cystic neoplasms of the pancreas are further subcategorized as either “mucin-producing cysts” (which may have malignant potential) or “non-mucin-producing cysts.”
    • Mucin-producing cysts, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, may have malignant potential and must be monitored carefully.
    • Serous cystadenomas are in the non-mucin-producing cyst category and are considered benign with no malignant potential. 

    Final recommendation

    The Munich Re team recognized that serous cystadenomas can often be identified by their characteristic imaging features. For asymptomatic people with classic imaging features of a serous cystadenoma, no further work-up is advised. Non-mucinous producing cysts, such as a serous cystadenoma, have no malignant potential and can be accepted at standard risk class for mortality risk. Morbidity risk can be covered with an exclusion.
    Contact the author
    Gina Guzman
    Dr. Gina Guzman
    Vice President & Chief Medical Officer
    Munich Re Life US
    Tim Meagher
    Dr. Tim Meagher MD, FRCPC, FACP
    Vice President & Medical Director
    Bradley Heltemes
    Dr. Bradley Heltemes, MD, DBIM, FAAIM
    Vice President and Medical Director of R&D
    Munich Re Life US
    John F. White III
    John F. White III, MD, MBA, DBIM, FLMI
    2nd VP Medical Director
    Medical Director, Munich RE US
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