0:00

This is a young female.

0:04

This is an 18-year-old female who had

0:06

a mass that was detected on ultrasound, actually.

0:10

And she saw the pancreatic mass in ultrasound

0:12

and wanted to get a CT scan to follow it up.

0:15

So I'll share with you the T2-weighted images

0:17

and maybe this time I'll zoom things up a little bit.

0:23

And so here's the mass, and it is arising from the pancreas.

0:28

I know it's somewhat tough to see this

0:30

in the pancreas here, but it's sort of arising and

0:33

sort of coming inferior to it

0:34

but it is arising, probably from the body

0:36

of the pancreas, complex-looking lesions

0:38

and hyperintense components and even T2 hypointense components.

0:43

This is what it looks like on the fat sat image.

0:45

You get a better look at it. I think it actually looks nicer here.

0:48

So the largest lesion, maybe about 3cm in changed.

0:51

This is the pre-contrast image, which I wanted to share with the group as well.

1:00

So that component that was over here looks like this on the T1-weighted images.

1:05

And because it's bright, then it goes straight to the subtraction images,

1:12

which on this particular scanner, look a little bit like this,

1:16

which are probably not ideal, but I apologize for that.

1:19

But I will window it so that you can have a look at this lesion.

1:25

And so here we go.

1:28

This is the lesion here.

1:33

A 3cm in size and complexity to it, 18-year-old female discovered

1:37

in the context, maybe some of, you know, nonspecific pain.

1:44

And so let's have the poll, see what we think is the best diagnosis.

1:49

I think that's the question.

1:50

So, again, a bunch of options here, we've seen examples of a bunch of these cases.

1:55

Main duct IPMN, SPEN, Adenocarcinoma, Serous cystadenoma.

2:01

Yeah, SPEN.

2:03

Yeah. And I think it's perhaps a function of the choices I've given you as well.

2:07

I find these, you know, there's no consistent appearance that

2:11

I find to SPENs, and it's only one of the things I think about

2:14

in the appropriate context, which is almost all are seen in females.

2:19

A lot of them are seen in younger females, particularly below the age of 35.

2:23

It can rise anywhere,

2:24

but often in the body until they don't have a communication in the duct.

2:27

They don't have malignant potential really, very, very low malignant potential.

2:31

But the larger they get, particularly more than 5cm,

2:34

they're more likely to be malignant or can have that malignant potential.

2:38

And it's almost always incidental.

2:41

And so what are you going to see on imaging.

2:43

Well, I think, you know,

2:43

this look is as good to look for a SPEN in the appropriate context as I've seen.

2:48

And that you'll see a pretty well encapsulated mass.

2:51

So you can draw, you know,

2:52

a nice little border to it, defining where the lesion sort of begins and ends.

2:58

There may be some calcifications, peripherally or centrally.

3:02

They have often have cystic components,

3:05

maybe a few small, smaller components.

3:08

One thing that has been described with SPEN

3:10

is this preponderance for them having hemorrhage.

3:12

And so when I see, you know,

3:14

a mass with hemorrhage in a young female body,

3:18

the pancreas,

3:19

some cystic components, some components that are enhancing.

3:22

Here, I think the enhancing components are very faint, but I think there are some

3:25

septations or other thicker components that are enhancing.

3:28

You know, I like to bring up the possibility of a SPEN.

3:31

Knowing that it's possible that I'm going

3:33

to be wrong sometimes, but particularly when there's hemorrhage,

3:36

that's not a feature that you see often with a lot of the other tumors.

3:41

Mucinous cystadenomas, you can't see T1 intense stuff

3:44

because of the mucin. But usually, that's not T2 hypointense,

3:48

like in this instance, which is what hemorrhage could look like.

3:51

Usually that mucin is a little bit more intermediate T2 signal.

3:55

And so I think, you know, you're not always going to be right

3:58

calling this prospectively, but I think if it's,

4:01

you know,

4:01

the appropriate context of a young female with a well-encapsulated tumor,

4:05

partially cystic, maybe some hemorrhage,

4:07

maybe a little bit of enhancement,

4:09

then it's something you certainly should raise in your differential.

4:11

And once again,

4:13

you've got to do an endoscopic ultrasound to verify that that's what it is.

4:16

And when it is that, treatment is resection

4:18

because there is that low malignant potential.