Hypervascular solid-appearing serous cystadenoma as a mimic of nonfunctioning pancreatic neuroendocrine tumour: a systematic review.
Mario Annecchiarico, Giuseppe Loiaco, Giulio Argenio et al.
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In 30 seconds
This PRISMA-aligned systematic review examined solid-appearing serous cystadenomas (SCA) that can mimic nonfunctioning pancreatic neuroendocrine tumours (NF-pNET), synthesizing comparative imaging cohorts separately from case reports and series. It included 35 publications: four retrospective single-centre cohorts and 31 case reports or series. In the cohorts, unenhanced CT attenuation was consistently lower in SCA than NF-pNET (18.5-29.6 vs. 38.8-48.4 HU), while diffusion-weighted MRI showed higher ADC values in SCA. Arterial hyperenhancement and somatostatin-receptor imaging uptake were not specific for NF-pNET.
Key findings
- Across comparative cohorts, unenhanced CT attenuation was 18.5-29.6 vs. 38.8-48.4 HU for SCA and NF-pNET, respectively.
- Reported DWI-ADC cutoffs favoring SCA were > 1.36 × 10 - 3 mm 2 /s and > 1.99 × 10 - 3 mm 2 /s.
- In case reports and series, arterial hyperenhancement occurred in 32/33 (97.0%) and 68 Ga-DOTA-peptide uptake in 17/39 (43.6%) of SCA cases.
- EUS-guided sampling was diagnostic in 9/17 (52.9%) of reported cases.
Why it matters
A benign SCA mistaken for NF-pNET may lead to pancreatic resection. The review highlights imaging features that may help distinguish these lesions, while showing that hyperenhancement and positive somatostatin-receptor imaging can occur in SCA and therefore do not establish NF-pNET. Considering multiple imaging features may help avoid overreliance on a single suggestive finding.
What to keep in mind
Evidence came from retrospective single-centre comparative cohorts of resected, pathology-proven lesions and case reports or series; no meta-analysis was performed. The authors caution that proposed imaging thresholds lack external validation.