Imaging feature and misdiagnosis reason of pancreatic neuroendocrine neoplasm with pancreatic duct obstruction / 第二军医大学学报

ABSTRACT

Objective To analyze the imaging feature and misdiagnosis reason of pancreatic neuroendocrine neoplasm (pNEN) with pancreatic duct obstruction. Methods The data of 25 patients with pNEN accompanied by pancreatic duct obstruction who underwent surgical treatment in our hospital from Jun. 2012 to Oct. 2018 were retrospectively analyzed. The imaging findings and misdiagnosis reason of pNEN were summarized by two senior radiologists. Results A total of 26 lesions in 25 patients were included, including six G1 tumors, 19 G2 tumors and one G3 tumor. The average size of the lesions was (2.5±1.7) cm (range, 0.4-9.1 cm). Of the 26 lesions, the main pancreatic duct was mildly dilated in 12 cases (46.2%), moderately dilated in eight cases (30.8%), and severely dilated in six cases (23.1%). Seventeen (65.4%) lesions were accompanied by severe atrophy of the upstream pancreatic parenchyma, six (23.1%) by moderate atrophy, one (3.8%) by mild atrophy, and two (7.7%) with no atrophy. Before operation, 14 (53.8%) lesions were correctly diagnosed as pNEN; and eight (30.8%) lesions were misdiagnosed as pancreatic cancer, two (7.7%) as solid pseudopapillar tumor, one (3.8%) as intraductal papillary mucinous neoplasm and one (3.8%) as serous cystadenoma. The main reasons of misdiagnosis included atypical lesion manifestations, insufficient understanding of atypical manifestations of the disease, inadequate observation of image details, less consideration of clinical data of the patients, etc. Conclusion It is difficult to differentiate pNEN with pancreatic duct obstruction from other pancreatic tumors. Being familiar with the atypical manifestations of the lesion, observing the image details carefully and understanding clinical data with imaging findings can help to reduce misdiagnosis and improve the accuracy of diagnosis.