title: Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours: a multicentre case series.
abstract: BACKGROUND
  Pancreatic neuroendocrine tumours are uncommon neoplasms which may rarely be cystic. Differentiation from other more common cystic neoplasms may be difficult.
  
  
  OBJECTIVE
  To describe the morphologic, cytologic, and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours.
  
  
  METHODS
  Retrospective analysis of consecutive patients referred for endosonographic evaluation of pancreatic cysts at four centres.
  
  
  RESULTS
  27 patients (12 males) with cystic pancreatic neuroendocrine tumours were identified. Prior to endosonography, this tumour was suspected in only 2 patients based on presenting symptoms (7.4%). The median cyst size was 35 mm (range 8-80 mm). Wall thickening was identified in 13 cases. The median carcinoembryonic antigen level was 1.25 (range 0.6-500). Fine needle aspiration cytology in 17 of 24 patients confirmed neuroendocrine tumour (71%). In 8 of 9 patients who had needle targeting of the cyst wall, cytology was consistent with neuroendocrine tumour (88.9%). 18 patients underwent surgical resection.
  
  
  CONCLUSIONS
  Cystic pancreatic neuroendocrine tumour was rarely suspected, including by cross-sectional imaging. Wall thickening was identified in approximately half of cases on endosonography. Cyst fluid was typically non-viscous with very low carcinoembryonic antigen levels. Targeting the wall during fine needle aspiration had a high diagnostic yield and should be performed.
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. Electronic address: henry.ho@yale.edu.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Ho
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.forename: Federico
authors.initials: F
authors.lastname: Rossi
authors.forename: Brenna W
authors.initials: BW
authors.lastname: Bounds
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D015331:Cohort Studies; D020420:Cyst Fluid / Q000737:chemistry*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D002272:Carcinoembryonic Antigen
keywords: Cyst fluid analysis; EUS; Fine needle aspiration; Neuroendocrine tumours; Pancreatic cysts