Skip to main content
SpringerLink
Log in

Hypervascular solid-appearing serous cystic neoplasms of the pancreas: Differential diagnosis with neuroendocrine tumours

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To describe imaging findings of arterial hypervascular solid-appearing serous cystic neoplasms (SCNs) of the pancreas on CT and MR and determine imaging features differentiating them from neuroendocrine tumours (NETs).

Materials and methods

We retrospectively identified 15 arterial hypervascular solid-appearing SCNs and randomly chose 30 size-matched pancreatic NETs. On CT, two radiologists in consensus assessed the size, morphology, and CT attenuation. On MR, predominant signal intensity and the amount of the cystic component on T2-weighted images and ADC maps were evaluated and compared using Fisher’s exact and Student’s t-test.

Results

The mean SCN size was 2.6 cm (range, 0.8–8.3). The CT findings were similar between the two tumours: location, shape, margin, and enhancement pattern. SCNs were significantly more hypodense on non-enhanced CT images than NETs (P = .03). They differed significantly on MR: bright signal intensity (P = .01) and more than a 10 % cystic component on T2-weighted images (P = .01) were more common in SCNs than in NETs. All SCNs showed a non-restrictive pattern on the ADC map, while NETs showed diffusion restriction (P < .01).

Conclusion

Arterial hypervascular solid-appearing SCNs and NETs share similar imaging features. Non-enhanced CT and MR images with T2-weighted images and ADC maps can facilitate the differentiation.

Key points

• Frequency of hypervascular solid-appearing SCNs was 7.3 % among surgically confirmed SCNs.

• Hypervascular solid-appearing SCN of the pancreas can mimic pancreatic NETs.

• Unenhanced CT and MR features help to differentiate the two tumours.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

CT:

Computed tomography

DW:

Diffusion-weighted

MR:

Magnetic resonance

NET:

Neuroendocrine tumours

SCN:

Serous cystic neoplasms

References

  1. Adsay NV, Klimstra DS, Compton CC (2000) Cystic lesions of the pancreas. Introduction. Semin Diagn Pathol 17:1–6

    CAS  PubMed  Google Scholar 

  2. Megibow AJ (2008) Chapter 100: Pancreatic neoplasms. In: Gore RM, Levine MS (eds) Textbook of gastrointestinal radiology. Saunders Elsevier, Philadelphia

    Google Scholar 

  3. Choi JY, Kim MJ, Lee JY, Lim JS, Chung JJ, Kim KW, Yoo HS (2009) Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. Am J Roentgenol 193:136–142

    Article  Google Scholar 

  4. Manfredi R, Ventriglia A, Mantovani W, Mehrabi S, Boninsegna E, Zamboni G, Salvia R, Mucelli RP (2014) Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization. European radiology:1–10

  5. Yamaguchi M (2006) Solid serous adenoma of the pancreas: a solid variant of serous cystadenoma or a separate disease entity? J Gastroenterol 41:178–179

    Article  PubMed  Google Scholar 

  6. Yasuda A, Sawai H, Ochi N, Matsuo Y, Okada Y, Takeyama H (2011) Solid variant of serous cystadenoma of the pancreas. Arch Med Sci 7:353–355

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sun HY, Kim SH, Kim MA, Lee JY, Han JK, Choi BI (2010) CT imaging spectrum of pancreatic serous tumors: based on new pathologic classification. Eur J Radiol 75:e45–e55

    Article  PubMed  Google Scholar 

  8. Stern JR, Frankel WL, Ellison EC, Bloomston M (2007) Solid serous microcystic adenoma of the pancreas. World J Surg Oncol 5:26

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sanaka MR, Kowalski TE, Brotz C, Yeo CJ, McCue P, Palazzo J (2007) Solid serous adenoma of the pancreas: a rare form of serous cystadenoma. Dig Dis Sci 52:3154–3156

    Article  PubMed  Google Scholar 

  10. Reese SA, Traverso LW, Jacobs TW, Longnecker DS (2006) Solid serous adenoma of the pancreas: a rare variant within the family of pancreatic serous cystic neoplasms. Pancreas 33:96–99

    Article  PubMed  Google Scholar 

  11. Machado M, Machado M (2008) Solid serous adenoma of the pancreas: an uncommon but important entity. Eur J Surg Oncology (EJSO) 34:730–733

    Article  CAS  Google Scholar 

  12. Yamamoto T, Takahashi N, Yamaguchi T, Imamura Y (2004) A case of solid variant type of pancreatic serous cystadenoma mimicking islet cell tumor. Clin Imaging 28:49–51

    Article  PubMed  Google Scholar 

  13. Gabata T, Terayama N, Yamashiro M, Takamatsu S, Yoshida K, Matsui O, Usukura M, Takeshita M, Minato H (2005) Solid serous cystadenoma of the pancreas: MR imaging with pathologic correlation. Abdom imaging 30:605–609

    Article  CAS  PubMed  Google Scholar 

  14. Hayashi K, Fujimitsu R, Ida M, Sakamoto K, Higashihara H, Hamada Y, Yoshimitsu K (2012) CT differentiation of solid serous cystadenoma vs endocrine tumor of the pancreas. Eu J Radiol 81:e203–e208

    Article  Google Scholar 

  15. Farrell JJ, Fernandez-del Castillo C (2013) Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology 144:1303–1315

    Article  PubMed  Google Scholar 

  16. Terris B, Fukushima N, Hruban RH (2010) Serous neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO Classification of Tumours of the Digestive System. IARC Press, Lyon, France, pp 296–299

    Google Scholar 

  17. Klimpstra DS, Arnold R, Capella C, Hruban RH, Kloppel G (2010) Neuroendocrine neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO Classification of Tumours of the Digestive System. IARC Press, Lyon, France, pp 322–326

    Google Scholar 

  18. Kim SY, Lee SS, Park B, Kim N, Kim JK, Park SH, Byun JH, Song KJ, Koo JH, Choi EK, Lee MG (2012) Reproducibility of measurement of apparent diffusion coefficients of malignant hepatic tumors: effect of DWI techniques and calculation methods. J Magn Reson Imaging : JMRI 36:1131–1138

    Article  PubMed  Google Scholar 

  19. Kim SY, Lee SS, Byun JH, Park SH, Kim JK, Park B, Kim N, Lee MG (2010) Malignant hepatic tumors: short-term reproducibility of apparent diffusion coefficients with breath-hold and respiratory-triggered diffusion-weighted MR imaging. Radiology 255:815–823

    Article  PubMed  Google Scholar 

  20. Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308

    Article  PubMed  Google Scholar 

  21. Kaza RK, Fidler, J.L., Macari, M., Takahashi, N., Megibow, A.J., Francis, i.R., Greenson, J. (2008) Imaging appearances of atypical serous cystic tumors of pancreas: a multi-institutional study. RSNA, 387

  22. Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, Sarr MG (2011) Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol 20:e84–e92

    Article  PubMed  Google Scholar 

  23. Heyn C, Sue-Chue-Lam D, Jhaveri K, Haider MA (2012) MRI of the pancreas: problem solving tool. J Magn Reson Imaging: JMRI 36:1037–1051

    Article  PubMed  Google Scholar 

  24. Buetow PC, Parrino TV, Buck JL, Pantongrag-Brown L, Ros PR, Dachman AH, Cruess DF (1995) Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status. AJR Am J Roentgenol 165:1175–1179

    Article  CAS  PubMed  Google Scholar 

  25. Kawamoto S, Johnson PT, Shi C, Singhi AD, Hruban RH, Wolfgang CL, Edil BH, Fishman EK (2013) Pancreatic neuroendocrine tumor with cystlike changes: evaluation with MDCT. AJR Am J Roentgenol 200:W283–W290

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wang Y, Miller FH, Chen ZE, Merrick L, Mortele KJ, Hoff FL, Hammond NA, Yaghmai V, Nikolaidis P (2011) Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics: Rev Publ Radiol Soc North Am Inc 31:E47–E64

    Article  Google Scholar 

  27. Brenner R, Metens T, Bali M, Demetter P, Matos C (2012) Pancreatic neuroendocrine tumor: Added value of fusion of T2-weighted imaging and high b-value diffusion-weighted imaging for tumor detection. Eur J Radiol 81:e746–e749

    Article  PubMed  Google Scholar 

  28. Barresi L, Tarantino I, Granata A, Curcio G, Traina M (2012) Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle. World J Gastrointest Endosc 4:247

    Article  PubMed  PubMed Central  Google Scholar 

  29. Belsley NA, Pitman MB, Lauwers GY, Brugge WR, Deshpande V (2008) Serous cystadenoma of the pancreas. Cancer Cytopathol 114:102–110

    Article  Google Scholar 

  30. Huang P, Staerkel G, Sneige N, Gong Y (2006) Fine‐needle aspiration of pancreatic serous cystadenoma. Cancer Cytopathol 108:239–249

    Article  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is Moon-Gyu Lee. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from Grant #2012R1A1A1012731 to the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology, Korea. The authors have no financial association that may pose a conflict of interests with the submitted manuscript. Seong Ho Park (one of the authors) has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. None of our study subjects have been previously reported.

Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Hye Sun Park, So Yeon Kim, Seong Ho Park, Seung Soo Lee, Jae Ho Byun, Jin Hee Kim, Hyoung Jung Kim & Moon-Gyu Lee

  2. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Seung-Mo Hong

Authors
  1. Hye Sun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. So Yeon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung-Mo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seong Ho Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seung Soo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jae Ho Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin Hee Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hyoung Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Moon-Gyu Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to So Yeon Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, H.S., Kim, S.Y., Hong, SM. et al. Hypervascular solid-appearing serous cystic neoplasms of the pancreas: Differential diagnosis with neuroendocrine tumours. Eur Radiol 26, 1348–1358 (2016). https://doi.org/10.1007/s00330-015-3961-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3961-3

Keywords

Search

Navigation