The imaging dilemma of solid serous cystadenomas, PNETs, and vascular pancreatic metastases: Challenges and...

Solid serous cystadenomas (SCAs) of the pancreas represent a rare subtype that can closely mimic malignant pancreatic lesions on imaging, leading to potential diagnostic pitfalls. While SCAs are typically benign cystic masses, the solid variant exhibits imaging patterns similar to some pancreatic neuroendocrine tumors (PNETs) and metastatic lesions, complicating their differentiation on cross-sectional modalities such as CT. In this pictorial review, we analyze both standard two-dimensional (2D) CT images and advanced three-dimensional (3D) cinematic rendering techniques to compare imaging features of solid SCAs with those of PNETs and pancreatic metastases. Accurate recognition is essential to avoid unnecessary surgical intervention, particularly since SCAs do not require resection, unlike their malignant counterparts. Through illustrative case examples, we emphasize overlapping characteristics and subtle distinguishing findings, highlighting the importance of correlating imaging with clinical history, prior malignancy, and ancillary findings. Enhanced awareness of this entity and its mimics can assist radiologists in forming a more accurate differential diagnosis on CT and guide appropriate management.