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.