Cystic changes of the pancreas comprise a variety of benign and malign lesions; however, five main entities represent 95% of all cystic pancreatic lesions. The five entities are pseudocysts, intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN) and solid pseudopapillary neoplasms (SPN). Whereas SCN and SPN have a good prognosis, IPMN and MCN have a risk of malignancy since they are potential precursors of the pancreatic ductal adenocarcinoma. Further distinction between the entities is based on epidemiology, localisation, communication with the duct system and pathology. A preoperative stratification according to these parameters is possible in many cases. This review proposes a clinically relevant classification and focuses on the five most common cystic lesions of the pancreas.