Cystic pancreatic neuroendocrine tumors: To date a diagnostic challenge

Abstract

Cystic neuroendocrine tumor in the pancreas underlines the clinical impact of endoscopic ultrasound in the work-up of patients with unclear lesions in the pancreas. EUS-FNA cytology and cyst fluid analysis is a useful adjunct to abdominal imaging for the diagnosis of pancreatic cystic lesions. Due to the evident diagnostic difficulties, we hypothesize that cyst fluid characteristics, including cytomorphological features, is the most accurate test to achieve a preoperative diagnosis and to provide a basis for prognostic prediction.

Cystic fluid chromogranin A levels in different pancreatic cystic lesions

“…Cystic PNETs are a rare entity that causes diagnostic challenge (15). In an asymptomatic patient, if CT reveals a cystic pancreatic lesion with thick cyst wall and hypervascular margins, it supports the diagnosis of cystic PNET.…”

Interesting pancreatic tumour in the background of Tuberous Sclerosis

“…The differentiation of lipid poor AML is difficult on diffusion characteristics of MRI alone. These lesions would be shown as characteristic low signal on T2-weighted imaging 5…”

Neuroendokrynne torbielowate nowotwory trzustki — punkt widzenia gastroenterologa

“…Most pancreatic cysts are either non-neoplastic lesions, like pseudocysts, or tumors with low (SCA), intermediate (IPMN-BD -branch duct intrapappilary mucinous neoplasma or higher potential of malignant transformation (MCN -mucinous cystic neoplasma, IPMN-MD -main duct intrapappilary mucinous) neoplasms, SPN -solid pappilary neoplasms). Pancreatic neuroendocrine tumours (PNEN) constitute about 5% of all pancreatic neoplasm with increasing incidence of 0.32/100,000/year [7,14]; among these, cystic lesions represent from 13 to 17% of all PNENs [15][16][17]. In the study by Bordeianou et.…”

“…It is suspected that they appear as a result of haemorrhage, necrosis, disturbances of the blood supply caused by the tumour capsule, intraductal growth, or cystic degeneration of solid PNENs [17,22]. However, there are a lot of clinical differences between solid and cystic neuroendocrine tumours [16]. In contrast to solid NENs, more common location of CPENs is distal pancreas rather than pancreatic head [17].…”

“…In contrast to solid NENs, more common location of CPENs is distal pancreas rather than pancreatic head [17]. Cystic tumours are also larger and more often symptomatic than solid PNENs [16,17]. It is worth mentioning that the presence of the cystic component correlates with the tumour size, and its extent is associated with better prognosis [18,23,24].…”