Variable Imaging Appearances and Diagnostic Certainty Challenges in Confirming Pancreatic Neuroendocrine Tumours...

A pancreatic neuroendocrine tumour (NET) originates from the neuroendocrine cells responsible for producing and releasing hormones. They are uncommon findings, mainly seen arising from the head of the pancreas and their appearances may vary among different imaging modalities.

Interesting case of an asymptomatic patient with an incidental finding of a pancreatic lesion and its variable appearances across different modalities and final histology findings.

Ultrasound (US) is the most requested examination as an imaging modality due to its easy accessibility, affordability, and real time assessment feature. This case shows that ultrasound examination although deemed poor in assessing pancreas due to its location and overlying bowel gas, however, can play a vital role especially among asymptomatic patients. It discusses the range of differentials diagnoses including pancreatic NET, Gastrointestinal stromal tumour (GIST), adenocarcinoma, mucinous cystic neoplasm, and a pseudo papillary neoplasm due to variable imaging appearances of the pancreatic lesion on US and Magnetic Resonance Imaging (MRI). Results were reviewed in the Upper Gastrointestinal Multidisciplinary teams meeting and Endoscopic ultrasound scan (EUS) with tissue sampling was undertaken to confirm the diagnosis. The patient underwent prophylactic surgery, and the histology report concluded that the lesion to be a pancreatic NET.

To conclude, we felt that sharing this interesting complex case was important as it highlights the difficulty in diagnostic certainty when dealing with a pancreatic lesion due to its variability in presentation on different modalities and the requirement of multidisciplinary team approach.