title: Cystic pancreatic neuroendocrine tumors: To date a diagnostic challenge.
abstract: OBJECTIVE
  Cystic PNETs are an uncommon neoplasms increasingly detected in current clinical practice which often present a diagnostic challenges to both the experienced radiologist and pathologist. The aim of this study was to review the available literature to summarize current data that compare and evaluate both the clinical and pathologic features of cystic pancreatic neuroendocrine tumors.
  
  
  METHODS
  A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting on cystic pancreatic neuroendocrine tumors. The MeSH search terms used were "cystic pancreatic neuroendocrine tumors", "endocrine neoplasms", and "pancreatic cysts". Multiple combinations of the keywords and MeSH terms were used.
  
  
  RESULTS
  The clinical evaluation of cystic pancreatic lesions appears to suffer from same limitations despite the improvement in the diagnostic tools. Subsequently, we highlight diagnostic pitfalls and differential diagnosis of these cystic tumors. In this review we discuss current advances in the application of the imaging modalities and characteristics features with special emphasize on endoscopic ultrasound (EUS), and EUS guide fine needle aspiration (EUS-FNA).
  
  
  CONCLUSIONS
  Cystic neuroendocrine tumor in the pancreas underlines the clinical impact of endoscopic ultrasound in the work-up of patients with unclear lesions in the pancreas. EUS-FNA cytology and cyst fluid analysis is a useful adjunct to abdominal imaging for the diagnosis of pancreatic cystic lesions. Due to the evident diagnostic difficulties, we hypothesize that cyst fluid characteristics, including cytomorphological features, is the most accurate test to achieve a preoperative diagnosis and to provide a basis for prognostic prediction.
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: cagliapi@unict.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caglià
authors.affiliation: Section of Radiology, Hospital of Delta-Lagosanto Ferrara, Italy. Electronic address: mariaterex@yahoo.it.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Cannizzaro
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: traciang@unict.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tracia
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: luka_amo@yahoo.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Amodeo
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: lucianotracia@me.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Tracia
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: a.buffone@unict.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Buffone
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: amodeo@unict.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Amodeo
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: cannizzaromatteoangelo@yahoo.it.
authors.forename: Matteo Angelo
authors.initials: MA
authors.lastname: Cannizzaro
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies
keywords: Cystic pancreatic neoplasms; Cystic pancreatic neuroendocrine tumors; Endoscopic ultrasound; Fine-needle aspiration biopsy