DOI: 10.1148/rg.264065012
Pancreatic Tumors in Children: Radiologic-Pathologic Correlation1
Ellen M. Chung, LTC, MC, USA,
Mark D. Travis, LCDR, MC, USN and
Richard M. Conran, COL, MC, USA
1 From the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Alaska and Fern streets NW, Washington, DC 20306-6000 (E.M.C.); the National Capitol Radiology Consortium, National Naval Medical Center, Bethesda, Md, and Walter Reed Army Medical Center, Washington, DC (M.D.T.); the Institute for Pediatric Medical Education, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.C.); and the Department of Pathology, Georgetown University School of Medicine, Washington, DC (R.M.C.). Received February 2, 2006; revision requested March 13 and received April 21; accepted April 21. All authors have no financial relationships to disclose.
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Figure 1a. Pancreatoblastoma in an 11-year-old girl who presented with abdominal pain, vomiting, and syncope after minor trauma. (a) Computed tomographic (CT) scan enhanced with intravenous contrast material shows a large, well-circumscribed, heterogeneous mass growing exophytically from the body and tail of the pancreas. Round, unenhancing cystic areas (arrow) and foci of intense enhancement (arrowheads) are noted within the mass. (b) Photograph of the cut surface of the resected gross specimen shows the encapsulated heterogeneous mass with cystic components filled with serous fluid (arrows). (c) Photomicrograph (original magnification, x16; hematoxylineosin [H-E] stain) shows small, rosette-like glandular structures (arrows) intermixed with solid sheets of uniform epithelial cells (arrowheads).
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Figure 1b. Pancreatoblastoma in an 11-year-old girl who presented with abdominal pain, vomiting, and syncope after minor trauma. (a) Computed tomographic (CT) scan enhanced with intravenous contrast material shows a large, well-circumscribed, heterogeneous mass growing exophytically from the body and tail of the pancreas. Round, unenhancing cystic areas (arrow) and foci of intense enhancement (arrowheads) are noted within the mass. (b) Photograph of the cut surface of the resected gross specimen shows the encapsulated heterogeneous mass with cystic components filled with serous fluid (arrows). (c) Photomicrograph (original magnification, x16; hematoxylineosin [H-E] stain) shows small, rosette-like glandular structures (arrows) intermixed with solid sheets of uniform epithelial cells (arrowheads).
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Figure 1c. Pancreatoblastoma in an 11-year-old girl who presented with abdominal pain, vomiting, and syncope after minor trauma. (a) Computed tomographic (CT) scan enhanced with intravenous contrast material shows a large, well-circumscribed, heterogeneous mass growing exophytically from the body and tail of the pancreas. Round, unenhancing cystic areas (arrow) and foci of intense enhancement (arrowheads) are noted within the mass. (b) Photograph of the cut surface of the resected gross specimen shows the encapsulated heterogeneous mass with cystic components filled with serous fluid (arrows). (c) Photomicrograph (original magnification, x16; hematoxylineosin [H-E] stain) shows small, rosette-like glandular structures (arrows) intermixed with solid sheets of uniform epithelial cells (arrowheads).
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Figure 2a. Solid-pseudopapillary tumor in a 12-year-old girl with a 2-week history of mild abdominal pain, nausea, vomiting, and pruritus. Laboratory examination revealed elevated results of liver function tests in an obstructive pattern. (a) CT scan enhanced with intravenous and oral contrast material shows a well-demarcated, predominantly hypoattenuating mass in the head of the pancreas. The mass deflects the superior mesenteric vein medially (curved arrow) and the common bile duct laterally (straight arrow). Note the dilated intrahepatic ducts (arrowheads). (b) Coronal CT image shows upward displacement of the main portal vein (arrow) by the mass. (c) Transverse color Doppler sonogram of the upper abdomen shows the heterogeneous mass with prominent peripheral vessels. (d) Photograph of the cut surface of the en bloc resected specimen shows the mass surrounding but not invading the opened common bile duct (arrow). Arrowhead = gallbladder, * = duodenum. (e) Photomicrograph (original magnification, x 16; H-E stain) shows the characteristic pseudopapillary formations of solid-pseudopapillary tumor (*).
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Figure 2b. Solid-pseudopapillary tumor in a 12-year-old girl with a 2-week history of mild abdominal pain, nausea, vomiting, and pruritus. Laboratory examination revealed elevated results of liver function tests in an obstructive pattern. (a) CT scan enhanced with intravenous and oral contrast material shows a well-demarcated, predominantly hypoattenuating mass in the head of the pancreas. The mass deflects the superior mesenteric vein medially (curved arrow) and the common bile duct laterally (straight arrow). Note the dilated intrahepatic ducts (arrowheads). (b) Coronal CT image shows upward displacement of the main portal vein (arrow) by the mass. (c) Transverse color Doppler sonogram of the upper abdomen shows the heterogeneous mass with prominent peripheral vessels. (d) Photograph of the cut surface of the en bloc resected specimen shows the mass surrounding but not invading the opened common bile duct (arrow). Arrowhead = gallbladder, * = duodenum. (e) Photomicrograph (original magnification, x 16; H-E stain) shows the characteristic pseudopapillary formations of solid-pseudopapillary tumor (*).
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Figure 2c. Solid-pseudopapillary tumor in a 12-year-old girl with a 2-week history of mild abdominal pain, nausea, vomiting, and pruritus. Laboratory examination revealed elevated results of liver function tests in an obstructive pattern. (a) CT scan enhanced with intravenous and oral contrast material shows a well-demarcated, predominantly hypoattenuating mass in the head of the pancreas. The mass deflects the superior mesenteric vein medially (curved arrow) and the common bile duct laterally (straight arrow). Note the dilated intrahepatic ducts (arrowheads). (b) Coronal CT image shows upward displacement of the main portal vein (arrow) by the mass. (c) Transverse color Doppler sonogram of the upper abdomen shows the heterogeneous mass with prominent peripheral vessels. (d) Photograph of the cut surface of the en bloc resected specimen shows the mass surrounding but not invading the opened common bile duct (arrow). Arrowhead = gallbladder, * = duodenum. (e) Photomicrograph (original magnification, x 16; H-E stain) shows the characteristic pseudopapillary formations of solid-pseudopapillary tumor (*).
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Figure 2d. Solid-pseudopapillary tumor in a 12-year-old girl with a 2-week history of mild abdominal pain, nausea, vomiting, and pruritus. Laboratory examination revealed elevated results of liver function tests in an obstructive pattern. (a) CT scan enhanced with intravenous and oral contrast material shows a well-demarcated, predominantly hypoattenuating mass in the head of the pancreas. The mass deflects the superior mesenteric vein medially (curved arrow) and the common bile duct laterally (straight arrow). Note the dilated intrahepatic ducts (arrowheads). (b) Coronal CT image shows upward displacement of the main portal vein (arrow) by the mass. (c) Transverse color Doppler sonogram of the upper abdomen shows the heterogeneous mass with prominent peripheral vessels. (d) Photograph of the cut surface of the en bloc resected specimen shows the mass surrounding but not invading the opened common bile duct (arrow). Arrowhead = gallbladder, * = duodenum. (e) Photomicrograph (original magnification, x 16; H-E stain) shows the characteristic pseudopapillary formations of solid-pseudopapillary tumor (*).
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Figure 2e. Solid-pseudopapillary tumor in a 12-year-old girl with a 2-week history of mild abdominal pain, nausea, vomiting, and pruritus. Laboratory examination revealed elevated results of liver function tests in an obstructive pattern. (a) CT scan enhanced with intravenous and oral contrast material shows a well-demarcated, predominantly hypoattenuating mass in the head of the pancreas. The mass deflects the superior mesenteric vein medially (curved arrow) and the common bile duct laterally (straight arrow). Note the dilated intrahepatic ducts (arrowheads). (b) Coronal CT image shows upward displacement of the main portal vein (arrow) by the mass. (c) Transverse color Doppler sonogram of the upper abdomen shows the heterogeneous mass with prominent peripheral vessels. (d) Photograph of the cut surface of the en bloc resected specimen shows the mass surrounding but not invading the opened common bile duct (arrow). Arrowhead = gallbladder, * = duodenum. (e) Photomicrograph (original magnification, x 16; H-E stain) shows the characteristic pseudopapillary formations of solid-pseudopapillary tumor (*).
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Figure 3a. Solid-pseudopapillary tumor in a 14-year-old girl who developed abdominal pain after sledding. (a) CT scan enhanced with intravenous contrast material shows a well-defined, fairly homogeneous, cystic mass arising in the tail of the pancreas (arrow). The mass enhances less than the adjacent normal pancreatic tissue. Arrowhead = splenic vein. (b) Axial T2-weighted MR image shows that the mass has heterogeneous internal signal intensity (arrow), which indicates that the mass is more complex than suggested by the CT findings. (c) Axial T1-weighted out-of-phase MR image shows that the mass has peripheral high signal intensity (arrow), a finding consistent with hemorrhage. (d) Axial gadolinium-enhanced MR image shows enhancement of only the capsule of the mass (arrow). (e) Photograph of the cut surface of the resected gross specimen shows the thick capsule (arrow) and predominantly gelatinous-appearing contents.
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Figure 3b. Solid-pseudopapillary tumor in a 14-year-old girl who developed abdominal pain after sledding. (a) CT scan enhanced with intravenous contrast material shows a well-defined, fairly homogeneous, cystic mass arising in the tail of the pancreas (arrow). The mass enhances less than the adjacent normal pancreatic tissue. Arrowhead = splenic vein. (b) Axial T2-weighted MR image shows that the mass has heterogeneous internal signal intensity (arrow), which indicates that the mass is more complex than suggested by the CT findings. (c) Axial T1-weighted out-of-phase MR image shows that the mass has peripheral high signal intensity (arrow), a finding consistent with hemorrhage. (d) Axial gadolinium-enhanced MR image shows enhancement of only the capsule of the mass (arrow). (e) Photograph of the cut surface of the resected gross specimen shows the thick capsule (arrow) and predominantly gelatinous-appearing contents.
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Figure 3c. Solid-pseudopapillary tumor in a 14-year-old girl who developed abdominal pain after sledding. (a) CT scan enhanced with intravenous contrast material shows a well-defined, fairly homogeneous, cystic mass arising in the tail of the pancreas (arrow). The mass enhances less than the adjacent normal pancreatic tissue. Arrowhead = splenic vein. (b) Axial T2-weighted MR image shows that the mass has heterogeneous internal signal intensity (arrow), which indicates that the mass is more complex than suggested by the CT findings. (c) Axial T1-weighted out-of-phase MR image shows that the mass has peripheral high signal intensity (arrow), a finding consistent with hemorrhage. (d) Axial gadolinium-enhanced MR image shows enhancement of only the capsule of the mass (arrow). (e) Photograph of the cut surface of the resected gross specimen shows the thick capsule (arrow) and predominantly gelatinous-appearing contents.
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Figure 3d. Solid-pseudopapillary tumor in a 14-year-old girl who developed abdominal pain after sledding. (a) CT scan enhanced with intravenous contrast material shows a well-defined, fairly homogeneous, cystic mass arising in the tail of the pancreas (arrow). The mass enhances less than the adjacent normal pancreatic tissue. Arrowhead = splenic vein. (b) Axial T2-weighted MR image shows that the mass has heterogeneous internal signal intensity (arrow), which indicates that the mass is more complex than suggested by the CT findings. (c) Axial T1-weighted out-of-phase MR image shows that the mass has peripheral high signal intensity (arrow), a finding consistent with hemorrhage. (d) Axial gadolinium-enhanced MR image shows enhancement of only the capsule of the mass (arrow). (e) Photograph of the cut surface of the resected gross specimen shows the thick capsule (arrow) and predominantly gelatinous-appearing contents.
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Figure 3e. Solid-pseudopapillary tumor in a 14-year-old girl who developed abdominal pain after sledding. (a) CT scan enhanced with intravenous contrast material shows a well-defined, fairly homogeneous, cystic mass arising in the tail of the pancreas (arrow). The mass enhances less than the adjacent normal pancreatic tissue. Arrowhead = splenic vein. (b) Axial T2-weighted MR image shows that the mass has heterogeneous internal signal intensity (arrow), which indicates that the mass is more complex than suggested by the CT findings. (c) Axial T1-weighted out-of-phase MR image shows that the mass has peripheral high signal intensity (arrow), a finding consistent with hemorrhage. (d) Axial gadolinium-enhanced MR image shows enhancement of only the capsule of the mass (arrow). (e) Photograph of the cut surface of the resected gross specimen shows the thick capsule (arrow) and predominantly gelatinous-appearing contents.
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Figure 4a. Insulinoma in a 9-year-old girl with unexplained seizure disorder who had hypoglycemia immediately after a recent seizure. (a) Contrast-enhanced CT scan shows a small, homogeneous, intensely enhancing mass (arrow) in the body and tail of the pancreas. (b) Photograph of the resected specimen shows the well-circumscribed tumor, which has protuberant red and yellow areas on the cut surface but no cystic spaces. (c) Photomicrograph (original magnification, x16; H-E stain) shows sheets of small uniform cells (arrows), which are separated into lobules by intervening fibrovascular stroma (arrowheads). (d) Photomicrograph (original magnification, x40; insulin stain) shows brown-staining insulin-producing cells in a trabecular pattern. (e) Photomicrograph (original magnification, x40; Congo red stain) obtained under polarized light shows apple-green birefringence (arrows), which is indicative of amyloid in the stroma, thus allowing a specific diagnosis of insulinoma.
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Figure 4b. Insulinoma in a 9-year-old girl with unexplained seizure disorder who had hypoglycemia immediately after a recent seizure. (a) Contrast-enhanced CT scan shows a small, homogeneous, intensely enhancing mass (arrow) in the body and tail of the pancreas. (b) Photograph of the resected specimen shows the well-circumscribed tumor, which has protuberant red and yellow areas on the cut surface but no cystic spaces. (c) Photomicrograph (original magnification, x16; H-E stain) shows sheets of small uniform cells (arrows), which are separated into lobules by intervening fibrovascular stroma (arrowheads). (d) Photomicrograph (original magnification, x40; insulin stain) shows brown-staining insulin-producing cells in a trabecular pattern. (e) Photomicrograph (original magnification, x40; Congo red stain) obtained under polarized light shows apple-green birefringence (arrows), which is indicative of amyloid in the stroma, thus allowing a specific diagnosis of insulinoma.
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Figure 4c. Insulinoma in a 9-year-old girl with unexplained seizure disorder who had hypoglycemia immediately after a recent seizure. (a) Contrast-enhanced CT scan shows a small, homogeneous, intensely enhancing mass (arrow) in the body and tail of the pancreas. (b) Photograph of the resected specimen shows the well-circumscribed tumor, which has protuberant red and yellow areas on the cut surface but no cystic spaces. (c) Photomicrograph (original magnification, x16; H-E stain) shows sheets of small uniform cells (arrows), which are separated into lobules by intervening fibrovascular stroma (arrowheads). (d) Photomicrograph (original magnification, x40; insulin stain) shows brown-staining insulin-producing cells in a trabecular pattern. (e) Photomicrograph (original magnification, x40; Congo red stain) obtained under polarized light shows apple-green birefringence (arrows), which is indicative of amyloid in the stroma, thus allowing a specific diagnosis of insulinoma.
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Figure 4d. Insulinoma in a 9-year-old girl with unexplained seizure disorder who had hypoglycemia immediately after a recent seizure. (a) Contrast-enhanced CT scan shows a small, homogeneous, intensely enhancing mass (arrow) in the body and tail of the pancreas. (b) Photograph of the resected specimen shows the well-circumscribed tumor, which has protuberant red and yellow areas on the cut surface but no cystic spaces. (c) Photomicrograph (original magnification, x16; H-E stain) shows sheets of small uniform cells (arrows), which are separated into lobules by intervening fibrovascular stroma (arrowheads). (d) Photomicrograph (original magnification, x40; insulin stain) shows brown-staining insulin-producing cells in a trabecular pattern. (e) Photomicrograph (original magnification, x40; Congo red stain) obtained under polarized light shows apple-green birefringence (arrows), which is indicative of amyloid in the stroma, thus allowing a specific diagnosis of insulinoma.
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Figure 4e. Insulinoma in a 9-year-old girl with unexplained seizure disorder who had hypoglycemia immediately after a recent seizure. (a) Contrast-enhanced CT scan shows a small, homogeneous, intensely enhancing mass (arrow) in the body and tail of the pancreas. (b) Photograph of the resected specimen shows the well-circumscribed tumor, which has protuberant red and yellow areas on the cut surface but no cystic spaces. (c) Photomicrograph (original magnification, x16; H-E stain) shows sheets of small uniform cells (arrows), which are separated into lobules by intervening fibrovascular stroma (arrowheads). (d) Photomicrograph (original magnification, x40; insulin stain) shows brown-staining insulin-producing cells in a trabecular pattern. (e) Photomicrograph (original magnification, x40; Congo red stain) obtained under polarized light shows apple-green birefringence (arrows), which is indicative of amyloid in the stroma, thus allowing a specific diagnosis of insulinoma.
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Figure 5a. Metastatic gastrinoma in an 8-year-old girl who presented with a several-month history of abdominal discomfort, chronic diarrhea, episodic vomiting, and black stools. Esophagogastroduodenoscopy revealed erosions and an ulcer in the gastric fundus and nodularity and two ulcers in the duodenum. Laboratory studies revealed no Helicobacter pylori and an elevated serum gastrin level. (a) Reformatted coronal image from CT arteriography shows an irregular but homogeneously enhancing mass in the region of the pancreatic head (straight arrow), a small enhancing mass in the left lobe of the liver (arrowhead), and thickening of gastric rugal folds (curved arrow). (b, c) Coronal single-photon-emission CT (SPECT) images from somatostatin receptor scintigraphy performed with indium 111–pentetreotide show localization of the radiopharmaceutical in the regions of the pancreatic head (straight solid arrow) and the left lobe of the liver (curved arrow in c), which correspond to the foci of abnormality on the CT image. The activity in the gallbladder (arrowhead in b) and kidney (open arrow in c) is physiologic.
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Figure 5b. Metastatic gastrinoma in an 8-year-old girl who presented with a several-month history of abdominal discomfort, chronic diarrhea, episodic vomiting, and black stools. Esophagogastroduodenoscopy revealed erosions and an ulcer in the gastric fundus and nodularity and two ulcers in the duodenum. Laboratory studies revealed no Helicobacter pylori and an elevated serum gastrin level. (a) Reformatted coronal image from CT arteriography shows an irregular but homogeneously enhancing mass in the region of the pancreatic head (straight arrow), a small enhancing mass in the left lobe of the liver (arrowhead), and thickening of gastric rugal folds (curved arrow). (b, c) Coronal single-photon-emission CT (SPECT) images from somatostatin receptor scintigraphy performed with indium 111–pentetreotide show localization of the radiopharmaceutical in the regions of the pancreatic head (straight solid arrow) and the left lobe of the liver (curved arrow in c), which correspond to the foci of abnormality on the CT image. The activity in the gallbladder (arrowhead in b) and kidney (open arrow in c) is physiologic.
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Figure 5c. Metastatic gastrinoma in an 8-year-old girl who presented with a several-month history of abdominal discomfort, chronic diarrhea, episodic vomiting, and black stools. Esophagogastroduodenoscopy revealed erosions and an ulcer in the gastric fundus and nodularity and two ulcers in the duodenum. Laboratory studies revealed no Helicobacter pylori and an elevated serum gastrin level. (a) Reformatted coronal image from CT arteriography shows an irregular but homogeneously enhancing mass in the region of the pancreatic head (straight arrow), a small enhancing mass in the left lobe of the liver (arrowhead), and thickening of gastric rugal folds (curved arrow). (b, c) Coronal single-photon-emission CT (SPECT) images from somatostatin receptor scintigraphy performed with indium 111–pentetreotide show localization of the radiopharmaceutical in the regions of the pancreatic head (straight solid arrow) and the left lobe of the liver (curved arrow in c), which correspond to the foci of abnormality on the CT image. The activity in the gallbladder (arrowhead in b) and kidney (open arrow in c) is physiologic.
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Figure 6a. Insulinoma in the tail of the pancreas in a 27-year-old man. (a) CT scan enhanced with intravenous contrast material shows irregular contour and enlargement of the pancreatic tail (arrow) but no well-defined mass. (b) Endoscopic US scan shows a slightly heterogeneous but well-defined, hypoechoic mass within the pancreatic tail.
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Figure 6b. Insulinoma in the tail of the pancreas in a 27-year-old man. (a) CT scan enhanced with intravenous contrast material shows irregular contour and enlargement of the pancreatic tail (arrow) but no well-defined mass. (b) Endoscopic US scan shows a slightly heterogeneous but well-defined, hypoechoic mass within the pancreatic tail.
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Figure 7a. Focal endocrine adenomatosis of the pancreas in a 1-month-old, 34-week gestation premature baby girl with persistent hypoglycemia and hyperinsulinism. Diazoxide therapy was unsuccessful, and the patient underwent 95% pancreatectomy. (a) Transverse sonogram of the upper abdomen shows heterogeneous enlargement of the neck and body of the pancreas (arrows) with cystic areas. (b) CT scan enhanced with intravenous contrast material shows a heterogeneous mass (arrow) in the neck and body of the pancreas. Arrowhead = splenic vein. (c) Photograph of the cut surface of the resected gross specimen shows the large, solid mass involving the head and body of the pancreas.
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Figure 7b. Focal endocrine adenomatosis of the pancreas in a 1-month-old, 34-week gestation premature baby girl with persistent hypoglycemia and hyperinsulinism. Diazoxide therapy was unsuccessful, and the patient underwent 95% pancreatectomy. (a) Transverse sonogram of the upper abdomen shows heterogeneous enlargement of the neck and body of the pancreas (arrows) with cystic areas. (b) CT scan enhanced with intravenous contrast material shows a heterogeneous mass (arrow) in the neck and body of the pancreas. Arrowhead = splenic vein. (c) Photograph of the cut surface of the resected gross specimen shows the large, solid mass involving the head and body of the pancreas.
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Figure 7c. Focal endocrine adenomatosis of the pancreas in a 1-month-old, 34-week gestation premature baby girl with persistent hypoglycemia and hyperinsulinism. Diazoxide therapy was unsuccessful, and the patient underwent 95% pancreatectomy. (a) Transverse sonogram of the upper abdomen shows heterogeneous enlargement of the neck and body of the pancreas (arrows) with cystic areas. (b) CT scan enhanced with intravenous contrast material shows a heterogeneous mass (arrow) in the neck and body of the pancreas. Arrowhead = splenic vein. (c) Photograph of the cut surface of the resected gross specimen shows the large, solid mass involving the head and body of the pancreas.
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Figure 8. Lymphoblastic lymphoma in a 17-year-old boy with epigastric pain for 3 days who was found to have elevated results of liver function tests and an elevated amylase level. CT scan enhanced with intravenous and oral contrast material shows diffuse, homogeneous enlargement of the pancreas. There is dilatation of the common bile duct (arrow) and intrahepatic ducts (arrowheads).
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Figure 9a. Lymphangioma of the pancreas in a 5-year-old boy with a 1-week history of abdominal pain and vomiting. (a) CT scan enhanced with intravenous and oral contrast material shows a predominantly cystic mass (straight arrows) in the pancreatic body and tail. The mass has an enhancing wall and multiple thin, enhancing septa (curved arrows). No solid components or surrounding inflammatory changes are evident. Arrowhead = splenic vein. (b) Photograph of the cut surface of the resected specimen shows the reddish mass with large cystic spaces (arrows), which are now drained of fluid.
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Figure 9b. Lymphangioma of the pancreas in a 5-year-old boy with a 1-week history of abdominal pain and vomiting. (a) CT scan enhanced with intravenous and oral contrast material shows a predominantly cystic mass (straight arrows) in the pancreatic body and tail. The mass has an enhancing wall and multiple thin, enhancing septa (curved arrows). No solid components or surrounding inflammatory changes are evident. Arrowhead = splenic vein. (b) Photograph of the cut surface of the resected specimen shows the reddish mass with large cystic spaces (arrows), which are now drained of fluid.
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Figure 10a. Mature teratoma of the pancreas in a 21-year-old woman who presented with a long history of nonspecific abdominal pain. CT scans enhanced with intravenous and oral contrast material show a complex mass arising in the body of the pancreas with foci of fat attenuation (* in a), very bright foci of calcific attenuation or intense enhancement (arrows in a), and a large cystic component (arrowheads in b).
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Figure 10b. Mature teratoma of the pancreas in a 21-year-old woman who presented with a long history of nonspecific abdominal pain. CT scans enhanced with intravenous and oral contrast material show a complex mass arising in the body of the pancreas with foci of fat attenuation (* in a), very bright foci of calcific attenuation or intense enhancement (arrows in a), and a large cystic component (arrowheads in b).
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Figure 11a. High-grade sarcoma of the head of the pancreas in a 10-year-old boy who presented with jaundice, nausea, and vomiting. (a) US scan shows an ill-defined, predominantly hypoechoic mass (arrows) in the pancreatic head and a dilated main pancreatic duct (arrowhead). (b) CT scan enhanced with intravenous contrast material shows the very heterogeneous mass with ill-defined borders in the region of the pancreatic head. There is mass effect on the gallbladder (arrow). Some small areas within the mass enhance intensely (arrowheads).
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Figure 11b. High-grade sarcoma of the head of the pancreas in a 10-year-old boy who presented with jaundice, nausea, and vomiting. (a) US scan shows an ill-defined, predominantly hypoechoic mass (arrows) in the pancreatic head and a dilated main pancreatic duct (arrowhead). (b) CT scan enhanced with intravenous contrast material shows the very heterogeneous mass with ill-defined borders in the region of the pancreatic head. There is mass effect on the gallbladder (arrow). Some small areas within the mass enhance intensely (arrowheads).
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Figure 12a. Pancreatitis complicated by pseudocyst formation in an 11-year-old girl with a history of cholelithiasis and acute epigastric pain and a markedly elevated serum amylase level. (a) CT scan enhanced with intravenous and oral contrast material and obtained in the acute setting shows an area of fluid attenuation (*) with an ill-defined enhancing margin and surrounding inflammatory change (arrows) adjacent to the pancreatic body and tail. (b) CT scan enhanced with intravenous contrast material and obtained weeks later shows a cyst with central fluid attenuation (*) and a well-defined, enhancing wall (arrows) adjacent to the pancreatic body and tail (arrowhead).
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Figure 12b. Pancreatitis complicated by pseudocyst formation in an 11-year-old girl with a history of cholelithiasis and acute epigastric pain and a markedly elevated serum amylase level. (a) CT scan enhanced with intravenous and oral contrast material and obtained in the acute setting shows an area of fluid attenuation (*) with an ill-defined enhancing margin and surrounding inflammatory change (arrows) adjacent to the pancreatic body and tail. (b) CT scan enhanced with intravenous contrast material and obtained weeks later shows a cyst with central fluid attenuation (*) and a well-defined, enhancing wall (arrows) adjacent to the pancreatic body and tail (arrowhead).
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Figure 13a. Congenital pancreatic cyst in a term newborn girl in whom a large abdominal cyst was diagnosed antenatally and who was found to have jaundice and elevated results of liver function tests. (a) Transverse sonogram of the fetal abdomen from a prenatal examination shows a round, anechoic cyst (arrow) on the opposite side of the J-shaped stomach (arrowhead). The smaller cystic structure between the two is a dilated biliary duct in cross section. (b) Postnatal contrast-enhanced CT scan shows the large simple cyst (*) on the right side with the stomach (arrowhead) on the left. Also note the multiple dilated biliary ducts (arrows).
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Figure 13b. Congenital pancreatic cyst in a term newborn girl in whom a large abdominal cyst was diagnosed antenatally and who was found to have jaundice and elevated results of liver function tests. (a) Transverse sonogram of the fetal abdomen from a prenatal examination shows a round, anechoic cyst (arrow) on the opposite side of the J-shaped stomach (arrowhead). The smaller cystic structure between the two is a dilated biliary duct in cross section. (b) Postnatal contrast-enhanced CT scan shows the large simple cyst (*) on the right side with the stomach (arrowhead) on the left. Also note the multiple dilated biliary ducts (arrows).
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Figure 14. Pancreatic retention cysts in a 17-year-old patient with cystic fibrosis who presented with renal colic and hematuria due to nephrolithiasis. CT scan enhanced with intravenous and oral contrast material shows multiple cysts in the pancreas (arrows) adjacent to the splenic vein (arrowhead).
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Copyright © 2006 by the Radiological Society of North America.
