Post written by Harry R. Aslanian, MD, from the Section of Digestive Disease, Yale New Haven Medical Center, School of Medicine, New Haven, Connecticut, USA.
We present a series of cases highlighting the EUS features of cystic pancreatic neuroendocrine tumors. Pancreas neuroendocrine tumors are rare and are less commonly cystic. The recognition and targeting of wall thickening with EUS-FNA is key to sonographic diagnosis. Targeting the wall is important as the cellularity and CEA level of the cyst fluid aspirate is typically low.
We present examples of the variable degrees of wall thickening of cystic pancreatic neuroendocrine tumors and demonstrate EUS-FNA targeting of the wall and the frequently cellular sample seen with on-site review.
Read the full article online.
The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
endoscopedia.com 
very interesting video case presentation. It should be considered the role of elastography and particularly contrast e.v. injection in the differential diagnosis of this lesions in comparison to other more frequent type of pancreatic cyst. The wall of the cystic NET are highly vascularized and present a quick hyper-enhance in the arterial phase after the injection and a very early wash out during venous phase. Elastography would show a homogeneous rigid blu pattern typical of tumors with high cellularity. These tools can significantly increase the yield of diagnostic EUS in this setting right before performing FNA.
Thanks for sharing your experience with contrast EUS and elastography. Contrast agents have not been available for use with EUS in the United States. Elastography has been available on some processors and recently as a software upgrade on others. We are beginning to evaluate the utility of these modalities in our clinical practice.
As seen in some of the examples of cross sectional images with contrast, wall enhancement can be an important indicator of a cystic NET on CT and MRI.