{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:03:48Z","timestamp":1784120628607,"version":"3.55.0"},"reference-count":31,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Pancreatic cysts include benign, premalignant and malignant lesions. Distinguishing them preoperatively remains challenging due to overlapping features. Serous cystadenomas are benign but can mimic other neoplasms, including pancreatic neuroendocrine tumours. We describe a case of a female in her 80s with an incidentally detected pancreatic tail mass and a history of resected melanoma. 18F-fluorodeoxyglucose positron emission tomography (PET) showed mild uptake, while chromogranin-A and urinary 5-hydroxyindoleacetic acid were slightly elevated. Magnetic resonance imaging (MRI) demonstrated a complex cystic lesion with a central scar favouring serous cystadenoma. However, gallium-68 PET and endoscopic ultrasound morphology raised suspicion for a pancreatic neuroendocrine tumour, with gallium uptake suggesting somatostatin receptor expression. Fine needle aspiration was non-diagnostic. Given the discordant findings and inability to exclude malignancy, robotic distal pancreatectomy and splenectomy were performed. Histopathology confirmed a benign serous cystadenoma. This case highlights the diagnostic challenges of pancreatic cysts and the potential for conflicting multimodal investigations.<\/jats:p>","DOI":"10.1136\/bcr-2026-273775","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:05:53Z","timestamp":1784117153000},"page":"e273775","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pancreatic serous cystadenoma masquerading as malignancy"],"prefix":"10.1136","volume":"19","author":[{"given":"Maddison","family":"Chokljat","sequence":"first","affiliation":[{"name":"Gastroenterology, Peninsula Health, Frankston, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5469-4317","authenticated-orcid":false,"given":"Joshua Haron","family":"Abasszade","sequence":"additional","affiliation":[{"name":"Gastroenterology, Peninsula Health, Frankston, Victoria, Australia"},{"name":"General Medicine, Northern Health, Epping, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Fisher","sequence":"additional","affiliation":[{"name":"Gastroenterology, Peninsula Health, Frankston, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Pilgrim","sequence":"additional","affiliation":[{"name":"Upper GI Surgery, Peninsula Health, Frankston, Victoria, Australia"},{"name":"Hepatobiliary Surgery, Alfred Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026071505052095000_19.7.e273775.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2013.01.010"},{"key":"2026071505052095000_19.7.e273775.2","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12237306","article-title":"Serous Cystadenoma: A Review on Diagnosis and Management","volume":"12","author":"Ning","year":"2023","journal-title":"J Clin Med"},{"key":"2026071505052095000_19.7.e273775.3","unstructured":"Khalid A , McGrath K . Classification of pancreatic cysts. UpToDate. Waltham, MA: UpToDate Inc, 2025."},{"key":"2026071505052095000_19.7.e273775.4","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-313127"},{"key":"2026071505052095000_19.7.e273775.5","doi-asserted-by":"crossref","first-page":"423","DOI":"10.5858\/133.3.423","article-title":"Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications","volume":"133","author":"Basturk","year":"2009","journal-title":"Arch Pathol Lab Med"},{"key":"2026071505052095000_19.7.e273775.6","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-309638"},{"key":"2026071505052095000_19.7.e273775.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2023.12.009"},{"key":"2026071505052095000_19.7.e273775.8","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.175.1.1750099"},{"key":"2026071505052095000_19.7.e273775.9","doi-asserted-by":"publisher","DOI":"10.1097\/00004728-199911000-00014"},{"key":"2026071505052095000_19.7.e273775.10","first-page":"171","article-title":"Cystic tumors of the pancreas: preoperative imaging, diagnosis, and treatment","volume":"87","author":"Kehagias","year":"2002","journal-title":"Int Surg"},{"key":"2026071505052095000_19.7.e273775.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(02)70440-9"},{"key":"2026071505052095000_19.7.e273775.12","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1002\/cncr.23346","article-title":"Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy","volume":"114","author":"Belsley","year":"2008","journal-title":"Cancer"},{"key":"2026071505052095000_19.7.e273775.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07530.x"},{"key":"2026071505052095000_19.7.e273775.14","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.suc.2019.04.014","article-title":"Evaluation and Management of Neuroendocrine Tumors of the Pancreas","volume":"99","author":"Scott","year":"2019","journal-title":"Surg Clin North Am"},{"key":"2026071505052095000_19.7.e273775.15","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.3748\/wjg.v26.i19.2305","article-title":"Pancreatic neuroendocrine tumors: A review of serum biomarkers, staging, and management","volume":"26","author":"Ma","year":"2020","journal-title":"World J Gastroenterol"},{"key":"2026071505052095000_19.7.e273775.16","doi-asserted-by":"publisher","DOI":"10.2217\/ije.14.40"},{"key":"2026071505052095000_19.7.e273775.17","doi-asserted-by":"publisher","DOI":"10.1159\/000471879"},{"key":"2026071505052095000_19.7.e273775.18","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.01.013"},{"key":"2026071505052095000_19.7.e273775.19","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1007\/s00261-018-1496-1","article-title":"Value of hepatocellular phase imaging after intravenous gadoxetate disodium for assessing hepatic metastases from gastroenteropancreatic neuroendocrine tumors: comparison with other MRI pulse sequences and with extracellular agent","volume":"43","author":"Tirumani","year":"2018","journal-title":"Abdom Radiol (NY)"},{"key":"2026071505052095000_19.7.e273775.20","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1159\/000080742","article-title":"Somatostatin and other peptide receptors as tools for tumor diagnosis and treatment","volume":"80 Suppl 1","author":"Reubi","year":"2004","journal-title":"Neuroendocrinology"},{"key":"2026071505052095000_19.7.e273775.21","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-012-9631-1"},{"key":"2026071505052095000_19.7.e273775.22","doi-asserted-by":"crossref","first-page":"7566","DOI":"10.3390\/curroncol30080549","article-title":"An Overview of Pancreatic Neuroendocrine Tumors and an Update on Endoscopic Techniques for Their Management","volume":"30","author":"Elkelany","year":"2023","journal-title":"Curr Oncol"},{"key":"2026071505052095000_19.7.e273775.23","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1097\/RLU.0000000000004857","article-title":"Increased Uptake in Microcystic Serous Cystadenoma Mimicking Pancreatic Neuroendocrine Tumor on 68 Ga-DOTATATE PET\/MRI","volume":"48","author":"Gao","year":"2023","journal-title":"Clin Nucl Med"},{"key":"2026071505052095000_19.7.e273775.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-020-01004-2","article-title":"Pancreatic serous cystoadenoma (CSA) showing increased tracer uptake at 68-GaDOTA-peptide Positron Emission Tomography (68Ga-DOTA-peptide PET-CT): a case report","volume":"20","author":"Nappo","year":"2020","journal-title":"BMC Surg"},{"key":"2026071505052095000_19.7.e273775.25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5348\/100097Z04EB2022EB","article-title":"Pancreatic serous cystadenoma with a high 68Ga DOTATOC-uptake mimicking a pancreatic NET","volume":"12","author":"A Bringeland","year":"2022","journal-title":"Int J Hepatobiliary Pancreat Dis"},{"key":"2026071505052095000_19.7.e273775.26","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/MPA.0000000000000319","article-title":"Somatostatin receptor subtype 2 expression and somatostatin receptor scintigraphy positivity in pancreatic serous cystadenomas","volume":"44","author":"Pot\u00e9","year":"2015","journal-title":"Pancreas"},{"key":"2026071505052095000_19.7.e273775.27","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics13040705","article-title":"Role of Endoscopic Ultrasound in the Evaluation of Pancreatic Cystic Neoplasms: A Concise Review","volume":"13","author":"Rangwani","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"2026071505052095000_19.7.e273775.28","first-page":"520","article-title":"Diagnosis of pancreatic neuroendocrine tumors and the role of endoscopic ultrasound","volume":"6","author":"Lee","year":"2019","journal-title":"Gastroenterol Hepatol (N Y)"},{"key":"2026071505052095000_19.7.e273775.29","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.114.148940"},{"key":"2026071505052095000_19.7.e273775.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2006.08.002"},{"key":"2026071505052095000_19.7.e273775.31","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/MCG.0000000000001468","article-title":"Needle-based Confocal Laser Endomicroscopy (nCLE) for Evaluation of Pancreatic Cystic Lesions: A Systematic Review and Meta-analysis","volume":"56","author":"Konjeti","year":"2022","journal-title":"J Clin Gastroenterol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-273775","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:06:00Z","timestamp":1784117160000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-273775"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2026-273775"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-273775","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}