Biological behavior characteristics and diagnosis and treatment strategies of cystic pancreatic neuroendocrine tumors
10.3760/cma.j.cn115610-20200217-00086
- VernacularTitle:囊性胰腺神经内分泌肿瘤生物学行为特征及诊断与治疗策略
- Author:
Hanxiang ZHAN
1
;
Jian YANG
Author Information
1. 山东大学齐鲁医院普通外科，济南 250012
- From:
Chinese Journal of Digestive Surgery
2020;19(4):388-393
- CountryChina
- Language:Chinese
-
Abstract:
Pancreatic neuroendocrine tumors (pNETs) are a highly heterogeneous group of neoplasms, which are predominantly solid and rarely present as cystic lesions. Due to the development and widespread use of cross-sectional imaging, such as CT and MRI examination, the detection rate of asymptomatic cystic pNETs has dramatically risen in the past decade. The etiology of cystic pNETs remains unclear. Despite several proposed hypothesis, the current studies still show contradictory results. Compared with solid pNETs, cystic pNETs are more likely to be non-functional and asymptomatic, and present with indolent biological behavior, such as lower Ki-67 proliferation index and mitotic count, less lymph node involvement and distant organ metastasis. The long-term prognosis of patients with cystic pNETs is also better compared with those with solid pNETs. However, a small part of cystic pNETs have invasive biological behavior. Preoperative diagnosis of this disease is challenging owing to the lack of specific imaging features. Endoscopic ultrasonography combined with fine needle aspiration can significantly improve the sensitivity and specificity in diagnosis of cystic pNETs. For its treatment strategy, all following factors, including clinical symptoms, tumor location, tumor size, degree of cystic component should be considered compre-hensively to individually make decision. Surgical resection is the standard procedure of cystic pNETs. Owing to its indolent behaviors, observation and active surveillance should be considered as an alternative to surgery for patients with non-functional, purely cystic and diameter less than 2 cm cystic pNETs. Combined with their own experience and relative literature, the authors make an investigation on the etiology, clinical characteristics, diagnosis and treatment strategies of cystic pNETs to provide reference for clinical treatment of surgeons.
