ARRS Case of the Week

GASTROINTESTINAL IMAGING: Pancreas

Case Author: Ramit Lamba, MBBS, MD, University of California, Davis

History

54-year-old woman with persistent fever and flank pain.

Imaging Findings

Axial CT images of the abdomen (A and B) show a well-circumscribed low-density predominantly exophytic mass with eccentric calcifications (arrow, A) originating from the proximal pancreatic tail. Axial delayed phase CT image (C) shows mild increasing enhancement in the tumor and an area of cystic degeneration (arrow). Axial T2-weighted fat-suppressed MR image (D) shows increased T2 signal intensity in the tumor. Unenhanced (E) and gadolinium-enhanced (F) T1-weighted fat-suppressed MR images show heterogeneous mild enhancement in the tumor.

  • Acinar cell carcinoma
  • Mucinous cystic tumor
  • Neuroendocrine tumor
  • Serous cystic tumor
  • Solid pseudopapillary neoplasm
  • Solitary fibrous tumor

Diagnosis

Solid pseudopapillary neoplasm

Teaching Points

Solid pseudopapillary neoplasms (SPNs) are rare tumors; most are found in young and middle-aged women. Large SPNs can have calcifications, a well-defined capsule, and cystic areas with necrosis and hemorrhage. Thus a large tumor can mimic a cystic neoplasm. Small SPNs (< 3 cm) tend to have atypical imaging features (purely solid, lack of calcifications, and isoattenuation to the pancreatic parenchyma in the venous phase).Because of their malignant potential, surgical resection is warranted in all cases of SPN.

Suggested Readings

Choi JY, Kim MJ, Kim JH, et al. Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. AJR 2006; 187:481; [web]W178–W186
Yao X, Ji Y, Zeng M, Rao S, Yang B. Solid pseudopapillary tumor of the pancreas: cross-sectional imaging and pathologic correlation. Pancreas 2010; 39:486–491

This page is updated with new content weekly. It was last updated on January 16, 2018.