Pancreatic solid serous cystadenoma treated by laparoscopy: Presentation of a new case report and review of the literature

Microcystic serous cystadenoma mimicking pancreatic neuroendocrine neoplasm: report of a resected case with preoperative diagnostic difficulty and review of the literature

Background

Microcystic pancreatic serous cystadenoma (SCA) can be managed without surgery in selected patients. However, the preoperative diagnosis of microcystic SCA remains challenging, and it is potentially misdiagnosed as other pancreatic cystic neoplasms or solid tumors, especially small microcystic SCA.

Case presentation

This was a case of a 27-year-old male patient with microcystic SCA causing difficulty in the differential diagnosis from pancreatic neuroendocrine neoplasm (pNEN). A pancreatic tail mass was incidentally discovered on abdominal ultrasound (US). A contrast-enhanced computed tomography (CT) scan revealed a solid tumor measuring 13 mm with early enhancement in the arterial phase at the pancreatic tail. The tumor showed low intensity on T1-weighted magnetic resonance image, high intensity on T2-weighted image, and a slightly hyperechoic mass on endoscopic US (EUS). EUS-fine needle aspiration (EUS-FNA) did not lead to a definitive diagnosis. The tumor was clinically diagnosed as a pNEN, and a laparoscopic spleen-preserving distal pancreatectomy using the Warshaw technique was performed. The final histopathological diagnosis was microcystic SCA.

Conclusion

Small microcystic SCA is difficult to distinguish from a hypervascular pancreatic tumor such as pNEN on imaging studies, and it is necessary to focus on the tumor echogenicity of EUS to differentiate microcystic SCA from pNEN preoperatively.

Monitored needle acceleration in endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses improves sample quality and diagnostic accuracy: a randomized trial

BACKGROUND : Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is recommended for the diagnosis of solid pancreatic masses. We aimed to evaluate whether a high needle movement acceleration value during puncture increases diagnostic accuracy. METHODS : EUS-FNA needle acceleration was measured using a PocketLab accelerometer connected by Bluetooth to a smartphone. Two passes (fast and slow, with higher and lower than 1g [9.8 m/s2] needle acceleration values, respectively) were performed in a random order. The sample cellularity and quality were measured using semiquantitative scales. RESULTS : 51 patients were included (32 women; mean age 63). The mean (standard deviation [SD]) acceleration values were 1.59g (0.66g) for the fast pass and 0.32g (0.19g) for the slow pass (P < 0.001). The fast pass yielded significantly higher levels of EUS-FNA accuracy (84.3 % vs. 68.6 %; P = 0.02) and adequate quality scores (94.1 % vs. 76.5 %; P = 0.007). High cellularity scores were seen with similar frequencies (15.7 % vs. 11.8 %; P = 0.32). CONCLUSIONS : A higher than 1g EUS-FNA needle acceleration may increase the diagnostic accuracy and specimen quality from solid pancreatic lesions.

Computed tomography and magnetic resonance imaging features of solid serous cystadenomas of the pancreas

Solid serous cystadenomas (SSC) of the pancreas are the rarest benign type of serous cystic neoplasms and are frequently misdiagnosed, resulting in unnecessary invasive surgical procedures. A retrospective study was performed to collect imaging features of SSC using computed tomography (CT) and magnetic resonance imaging. The clinical data and imaging study of 5 female patients with pathologically confirmed SSC (mean age, 44.2 years; range, 23-69 years) diagnosed between January 2006 and July 2017 were retrospectively analyzed. The imaging study was assessed by two experienced radiologists in consensus. All patients had tumors with a mean size of 2.3 cm (range, 1.5-3.2 cm; 4/5 lesions ≤3 cm). The tumors were located in the tail of pancreas in 3 cases and in the neck of the pancreas in 2 cases. The tumors were all well defined, with an ovoid and lobulated shape and fibrous capsules. Consequently, they presented as low density on unenhanced CT images, marked hyperintensity on T2-weighted images in 4 cases and slight hyperintensity in 1 case. However, they exhibited heterogeneous wash-in and wash-out enhancement in 2 cases and moderate and prolonged enhancement in 3 cases. The apparent diffusion coefficient (ADC) values of the lesions were >2×10^-3 mm²/sec. Therefore, a small tumor size, signal intensity on T2-weighted images, high ADC values, fibrous capsules and enhancement patterns may be indicative imaging features of SSCs.