Pancreatic cystic lesions are diagnosed more frequently because of widespread use of CT scan in clinical practise. The incidence of cystic lesions increases with age. These lesions possess difficult problem in differentiating between benign and malignant cyst. These cystic lesions may be pseudocyst, congenital cyst or cystic neoplasm. Pancreatic cystic neoplasms (PCN) are classified as serous cystic neoplasm (SCN), mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN) and solid pseudopapillary neoplasm. SCN are subdivided into serous cyst adenoma, serous microcystic adenoma, serous oligocystic adenoma, solid variant of serous cyst adenoma and serous cystadenocarcinoma. SCN are also associated with von Hippel-Lindau syndrome. MCN are the commonest PCN, lined by mucin secreting columnar epithelium. The presence of ovarian type stroma is pathognomonic of MCN. IPMN are characterized by intraductal proliferation of mucinous cell forming micro and macropapillae, and cystic dilation of main pancreatic duct and /or secondary branches. These are classified based on morphological changes of ductal system: main duct, branch duct and mixed type IPMN. PCN present with non-specific symptoms or discovered incidentally on imaging. Lesions are evaluated with CT scan, MRI or EUS. High level of CEA (>192 ng/ml) in intracystic fluid differentiates mucinous from nonmucinous lesions. Treatment of symptomatic SCN, MCN, main duct and large side branch IPMN is surgery.