A single-center experience with pancreatic cystic neuroendocrine tumors

Cinematic Rendering of Pancreatic Neuroendocrine Tumours: Opportunities for Clinical Implementation: Part 1: Tumour Detection and Characterization

Pancreatic neuroendocrine tumours (PNETs) are a rare subset of pancreatic tumours that have historically comprised up to 3% of all clinically detected pancreatic tumours. In recent decades, however, advancements in imaging have led to an increased incidental detection rate of PNETs and imaging has played an increasingly central role in the initial diagnostics and surgical planning of these tumours. Cinematic rendering (CR) is a 3D post-processing technique that generates highly photorealistic images through more realistically modelling the path of photons through the imaged volume. This allows for more comprehensive visualization, description, and interpretation of anatomical structures. In this 2-part review article, we present the first description of the various CR appearances of PNETs in the reported literature while providing commentary on the unique clinical opportunities afforded by the adjunctive utilization of CR in the workup of these rare tumours. The first of these 2 instalments highlights the utility of CR in optimizing PNET detection and characterization.

Clinicopathological features and long-term prognosis of purely cystic pancreatic neuroendocrine tumors: A single-center experience

BACKGROUND

Pancreatic neuroendocrine tumors (pNETs) are heterogenous neoplasms, of which the prognosis varies widely. Purely cystic pancreatic neuroendocrine tumors (C-pNETs) are a small subset of pNETs in which data are extremely rare. This study aimed to compare clinicopathological and long-term survival differences between C-pNETs and solid pNETs (S-pNETs).

METHODS

A retrospective review of 242 patients with pNETs underwent resection in our institution from 2009 to 2019 was conducted. Demography characteristics, clinicopathological features and long-term outcomes of them were analyzed.

RESULTS

Sixteen out of 242 patients (6.6%) were identified as C-pNETs. Compared with S-pNETs, C-pNETs were more frequently non-functional (75% vs 45%, P = 0.02), and the median tumor diameter of C-pNETs was smaller (36 mm vs. 47 mm, P = 0.001). And the accuracy of preoperative diagnosis of C-pNETs was significantly lower (31% vs 78%, P = 0.001). Of note, the majority of C-pNETs were well-differentiated with G1 (81% vs 35%, P = 0.001). And there were no G3 (0 vs 7%, P = 0.001) in C-pNETs. No T4 stage or R1/R2 surgical margin detected in C-pNETs. And only one C-pNETs (6%) had regional lymph node metastasis (N) or synchronous distant metastasis (M). Additionally, only one patient with C-pNETs (6%) suffered tumor recurrence, compared with 24 (13%) for S-pNETs. And survival analysis showed the patients with C-pNETs seemed to be with better disease-free survival (P = 0.26).

CONCLUSION

C-pNETs are rare subtype with possibly less aggressive behavior comparing with their solid counterparts. Recurrence and tumor-related death still occurs in patients with resected C-pNETs, although they tend to be with more favorable prognosis.

Cystic Pancreatic Neuroendocrine Tumor: A Diagnostic Dilemma

Pancreatic neuroendocrine tumors are typically solid neoplasms but in rare instances may present as cystic lesions. Preoperative diagnosis of a cystic pancreatic lesion is challenging and requires a multidisciplinary and multimodal approach. We hereby describe an elderly female who came with complaints of abdominal lump. Radiologically, it appeared to be a pancreatic hydatid cyst located at the head of the pancreas, following which resection was done. Histopathological study of the lesion turned out to be a cystic pancreatic neuroendocrine tumor. Thus, we present this unique case due to its rarity and diagnostic challenge.

Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery

Parenchymal sparing duodenal and pancreatic resection are safe procedures in selected patients with the aim to reduce endocrine and exocrine long-term dysfunction. When the tumor is benign or borderline malignant, this appears to be a good option for the surgeon, associated with low rates of severe surgery-related early postoperative complications and low in-hospital mortality. This mini review offers comments, tips and tricks, and a review of literature concerning those different options with specific illustrations in order to clarify their indication.