Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours: a multicentre case series

Henry C Ho, Mohamad A Eloubeidi, Uzma D Siddiqui, William R Brugge, Federico Rossi, Brenna W Bounds, Harry R Aslanian
Digestive and Liver Disease 2013, 45 (9): 750-3

BACKGROUND: Pancreatic neuroendocrine tumours are uncommon neoplasms which may rarely be cystic. Differentiation from other more common cystic neoplasms may be difficult.

AIMS: To describe the morphologic, cytologic, and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours.

METHODS: Retrospective analysis of consecutive patients referred for endosonographic evaluation of pancreatic cysts at four centres.

RESULTS: 27 patients (12 males) with cystic pancreatic neuroendocrine tumours were identified. Prior to endosonography, this tumour was suspected in only 2 patients based on presenting symptoms (7.4%). The median cyst size was 35 mm (range 8-80 mm). Wall thickening was identified in 13 cases. The median carcinoembryonic antigen level was 1.25 (range 0.6-500). Fine needle aspiration cytology in 17 of 24 patients confirmed neuroendocrine tumour (71%). In 8 of 9 patients who had needle targeting of the cyst wall, cytology was consistent with neuroendocrine tumour (88.9%). 18 patients underwent surgical resection.

CONCLUSIONS: Cystic pancreatic neuroendocrine tumour was rarely suspected, including by cross-sectional imaging. Wall thickening was identified in approximately half of cases on endosonography. Cyst fluid was typically non-viscous with very low carcinoembryonic antigen levels. Targeting the wall during fine needle aspiration had a high diagnostic yield and should be performed.

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