Presentation
Weight loss.
Patient Data
No evidence of chronic or acute pancreatitis. There is a 3.9 cm x 3.2 cm x 3.2 cm well defined - almost encapsulated appearing - solid enhancing pancreatic head mass demonstrating quite vivid arterial enhancement with persistent hyper enhancement relative to pancreatic parenchyma on portal venous phase. Small non-enhancing cystic spaces are shown, which may represent small areas of necrosis. The mass does not cause main pancreatic duct dilatation or biliary dilatation. The mass is closely associated with the proximal portal vein. The portal vein is slightly displaced and deformed but has a smooth margin where there is contact with the mass. There is a short distance of central superior mesenteric vein in contact with the mass. Contact points at portal vein and superior veins are less than
Celiac axis, hepatic artery, superior mesenteric artery are clear. No lymphadenopathy.
Within segment 5 of the liver, there is a wedge-shaped area of arterial hyper enhancement, without washout of seen on prior exam. Within segment 8, there is a small focus of arterial hyperenhancement without washout, which may represent a similar phenomenon.
Left renal cyst. While both kidneys, adrenal glands, spleen are normal in appearance. Visible bones are normal in appearance.
Conclusion: Pancreatic head mass, abutting the proximal portal vein without clear evidence of invasion. Differential diagnosis includes neuroendocrine tumor; appearances are not typical for adenocarcinoma. Seg. VIII hypervascular liver lesion is indeterminate. Seg. V hypervascular liver area may represent a THID/THAD.
Suggest consider correlation with EUS/FNA.
Pancreatic head mass lesion, well defined with no vascular invasion noted.
No enlarged lymph nodes are visualized.
Biopsy was performed, there were no complications.
Case Discussion
Histopathology
MICROSCOPIC DESCRIPTION: The smears and cell block section contain scattered groups and cords of atypical epithelial cells. These cells have enlarged round nuclei, granular chromatin, small nucleoli and moderate amounts of cytoplasm. No mitoses or necrosis is seen. The tumor cells are synaptophysin, chromogranin and CD56 positive. The Ki-67 index is about 2%. The features are those of neuroendocrine tumor (WHO grade 1).
DIAGNOSIS: Neuroendocrine tumor.
Most endocrine pancreatic tumors are functional, secreting an active hormone, e.g. gastrin, insulin, or a vasoactive intestinal polypeptide (VIP).
This patient had a non-functioning neuroendocrine tumor, which is far less common.
These tumors tend to be highly vascular on CTA; they may contain calcification and cysts.
Invasion of adjacent vascular structures is seen less commonly than in adenocarcinoma of the pancreas.
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