CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2018 Luglio-Agosto;5(4):545-9

DOI: 10.23736/S2283-8376.18.00097-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Unusual cystic appearance of a neuroendocrine pancreatic tumor: how radiologic findings can help in differential diagnosis

Michele FORESTI ¹ ✉, Luca COTTAFAVI ², Elisa GASPARINI ², Alessandro GIUNTA ³, Lorenzo GHIDDI ¹

¹ UOS Radiologia, Dipartimento Diagnostica per Immagini e Medicina di Laboratorio, Ospedale C. Magati Scandiano, Azienda USL-IRCC, Reggio Emilia, Italia; ² Dipartimento Oncologico e Tecnologie Avanzate Azienda USL-IRCC, Medicina Oncologica Area Sud, Ospedale C. Magati Scandiano, Reggio Emilia, Italia; ³ Dipartimento Oncologico e tecnologie Avanzate Azienda USL-IRCC ASMN, Chirurgia Generale a indirizzo Oncologico e Ricostruttivo, Reggio Emilia, Italia

Pancreatic neuroendocrine tumors (pNETs) are unusual findings showing a 5-10% cases per million habitants per year incidence. Cystic degeneration of a pNET is an even more rare event, representing about 2-10% of all endocrine pancreatic tumors. These tumors can have two backgrounds: the first as a sporadic event between 6th and 7th decade, the second in patients with MEN-1, often young with multiple tumors. Cystic pNETs are often non-functioning tumors found as incidentalomas and can represent a clinical-diagnostic challenge because asymptomatic and sometimes showing radiologic findings similar to other pancreatic cystic lesions. Radiological differential diagnosis between cystic pNETs and other cystic pancreatic lesions, when possible, has a significative role for the subsequent clinical and therapeutically management, because some lesions have a typical benign behavior and can be monitored by radiologic follow-up, while other lesions must be submitted to surgical resection since malignant or suspected for malignancy. We present a case report in which radiological findings of a cystic pancreatic lesion with hypervascular even thickened walls rim-enhancement found accidentally during a CT exam for a huge retrocardiac hiatal hernia characterization, allowed the suspect of a non-functioning cystic pNET, confirmed by histologic analysis after distal splenopancreatectomy.

KEY WORDS: Pancreatic neoplasms - Neuroendocrine tumors - Tomography, X-ray computed