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Background <p>Solid pancreatic serous cystadenoma (SCA) may present as a hypervascular mass and mimic nonfunctioning pancreatic neuroendocrine tumour (NF-pNET), potentially leading to pancreatic resection for benign disease. We synthesized the available evidence on this diagnostic pitfall.</p> Methods <p>A PRISMA 2020–aligned systematic review searched MEDLINE, Embase, and Web of Science (1 January 2000–1 December 2025). We included comparative cohorts of pathology-proven SCA versus NF-pNET reporting CT/MRI discriminative features and case reports/series of pathology-proven SCA preoperatively interpreted as NF-pNET. Comparative cohorts and case reports/series were synthesized separately; no meta-analysis was performed.</p> Results <p>Thirty-five publications were included: four retrospective single-center comparative cohorts (50 SCA and 89 NF-pNET patients) and 31 case reports/series (39 SCA patients). In comparative cohorts, unenhanced CT attenuation was consistently lower in SCA than in NF-pNET (18.5–29.6 vs. 38.8–48.4 HU), with study-specific ROC-derived cutoffs in the low 30-HU range; attenuation ratios performed similarly. Diffusion-weighted MRI showed higher ADC values in SCA, with reported study-specific cutoffs of &gt; 1.36 × 10<sup>− 3</sup> mm<sup>2</sup>/s and &gt; 1.99 × 10<sup>− 3</sup> mm<sup>2</sup>/s. In case reports/series, arterial hyperenhancement occurred in 32/33 (97.0%), <sup>68</sup>Ga-DOTA–peptide uptake in 17/39 (43.6%), and EUS-guided sampling was diagnostic in 9/17 (52.9%).</p> Conclusions <p>NF-pNET–mimicking SCA is an uncommon but clinically consequential benign mimic. In the available retrospective comparative cohorts of resected, pathology-proven lesions, lower unenhanced CT attenuation (and attenuation ratios) and higher DWI–ADC values consistently favored SCA over NF-pNET, whereas arterial hyperenhancement and positive somatostatin receptor imaging uptake were not specific. These findings may support cautious multiparametric assessment in selected hypervascular solid-appearing pancreatic lesions, but should not be applied as definitive diagnostic thresholds without external validation.</p>

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Hypervascular solid-appearing serous cystadenoma as a mimic of nonfunctioning pancreatic neuroendocrine tumour: a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月25日

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  • Mario Annecchiarico,
  • Giuseppe Loiaco,
  • Giulio Argenio,
  • Antonio Varricchio,
  • Gianluca Rompianesi,
  • Roberto Cannella

摘要

Background

Solid pancreatic serous cystadenoma (SCA) may present as a hypervascular mass and mimic nonfunctioning pancreatic neuroendocrine tumour (NF-pNET), potentially leading to pancreatic resection for benign disease. We synthesized the available evidence on this diagnostic pitfall.

Methods

A PRISMA 2020–aligned systematic review searched MEDLINE, Embase, and Web of Science (1 January 2000–1 December 2025). We included comparative cohorts of pathology-proven SCA versus NF-pNET reporting CT/MRI discriminative features and case reports/series of pathology-proven SCA preoperatively interpreted as NF-pNET. Comparative cohorts and case reports/series were synthesized separately; no meta-analysis was performed.

Results

Thirty-five publications were included: four retrospective single-center comparative cohorts (50 SCA and 89 NF-pNET patients) and 31 case reports/series (39 SCA patients). In comparative cohorts, unenhanced CT attenuation was consistently lower in SCA than in NF-pNET (18.5–29.6 vs. 38.8–48.4 HU), with study-specific ROC-derived cutoffs in the low 30-HU range; attenuation ratios performed similarly. Diffusion-weighted MRI showed higher ADC values in SCA, with reported study-specific cutoffs of > 1.36 × 10− 3 mm2/s and > 1.99 × 10− 3 mm2/s. In case reports/series, arterial hyperenhancement occurred in 32/33 (97.0%), 68Ga-DOTA–peptide uptake in 17/39 (43.6%), and EUS-guided sampling was diagnostic in 9/17 (52.9%).

Conclusions

NF-pNET–mimicking SCA is an uncommon but clinically consequential benign mimic. In the available retrospective comparative cohorts of resected, pathology-proven lesions, lower unenhanced CT attenuation (and attenuation ratios) and higher DWI–ADC values consistently favored SCA over NF-pNET, whereas arterial hyperenhancement and positive somatostatin receptor imaging uptake were not specific. These findings may support cautious multiparametric assessment in selected hypervascular solid-appearing pancreatic lesions, but should not be applied as definitive diagnostic thresholds without external validation.