Upcoming Events
Log In
Pricing
Free Trial

Watch this case review for free!

HIDE
PrevNext

0:03

with a pancreatic mass, which

0:05

we have to characterize now.

0:07

And I will start with T1 fat-suppressed,

0:11

non-contrast-enhanced images here.

0:14

And we see this expansive large mass in

0:16

the pancreatic tail, which shows multiple

0:19

areas of heterogeneous T1 hyperintensities

0:23

along with the periphery of this lesion.

0:26

So that gives us an idea that possibly

0:27

this lesion actually has some internal

0:30

hemorrhages or hypertense content.

0:34

And if we correlate this with T2-weighted images,

0:38

we find that this, this entire thing which was

0:41

looking T1 hyperintense actually is T2 hyper

0:44

intense, so that further reinforces our thought

0:48

that it is possibly hemorrhagic content here.

0:51

But this tumor looks like

0:52

necrotic at multiple locations.

0:54

It is very big espine cell involving the

0:58

pancreatic tail in a young female patient.

1:01

So that is a daughter tumor.

1:04

That means it is SPN.

1:07

So, let us see how it behaves

1:08

in the arterial phase.

1:10

On the arterial phase, we can see

1:12

most of the tumor is not enhancing,

1:14

only the periphery is enhancing.

1:18

And then, if we go to the venous

1:21

phase, we can see it better, the non

1:24

enhancing part and enhancing part.

1:27

But if we compare it with the, the one we

1:29

started with the arterial phase, if we see the

1:32

enhancement pattern on the arterial phase, the

1:34

periphery of this lesion is enhancing like a rim.

1:37

Like, there is a claw formed here, and

1:40

almost everything along with the periphery is

1:41

enhancing, but the center is not enhancing.

1:43

It's mostly necrotic, mostly it

1:45

is replaced by hemorrhagic tissue.

1:48

The point is, given the age, given

1:50

the presentation along with the tail,

1:53

given the gender, it favors it as SPN.

1:56

But sometimes the same appearance can

1:57

be seen with neuroendocrine tumors.

1:59

Those are non-functional.

2:00

They can grow up to this extent and

2:02

they can undergo necrosis as well.

2:04

But usually that necrosis is not

2:05

that striking as in this case is.

2:09

So, in the case of neuroendocrine tumor,

2:11

when it is necrotic, you will still see

2:12

some of the enhancing soft tissue, and that

2:14

will enhance more during the arterial phase.

2:17

And then, non-functional neuroendocrine

2:19

tumor, still you can have tumor markers.

2:21

And patient age group can be

2:22

different, patient can be male as well.

2:24

But in this particular patient, given this

2:26

patient's presentation and the appearance of

2:28

the tumor, uh, we gave the diagnosis of SPN, and

2:32

it was proven on the postoperative pathology.

Report

Faculty

Neeraj Lalwani, MD, FSAR, DABR

Professor and Chief of Abdominal Radiology

Montefiore Medical Center, New York

Tags

Pancreas

Oncologic Imaging

Gastrointestinal (GI)

Body

© 2025 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy