Presentation
Raised CEA; prominent ampulla on esophagogastroduodenoscopy (EGD).
Patient Data
Pancreatic mass with the following characteristics:
Located in the tail, 3 cm from the tip (the tail is long, extending inferior to the spleen), it measures 18 x 25 x 16 cm. Hypodense with 6 mm nodule calcification at the center, margins discrete but not smooth. It shows avid solid contrast enhancement only in the arterial phase, with contrast washout in the venous phase (enhancement does not parallel blood vessels, so the lesion is not an aneurysm). There was no dilatation of the pancreatic duct distal to the lesion, no atrophy of the tail parenchyma distal to the lesion, and no local peripancreatic infiltration.
Ampulla characteristics:
Measuring 8 x 8 x 8 mm and protruding into the duodenal lumen. No arterial enhancement with moderate venous enhancement similar to duodenal wall; enhancement does not appear mass-like. Pancreaticoduodenal groove fat is normal.
Liver characteristics:
Solitary 16 x 17 x 14 mm nodule in the superior subcapsular aspect of segment II; the nodule is hyper-vascular in arterial phase and washed out and becomes imperceptible in porto-venous phase. The enhancement pattern parallels that of the pancreatic tail mass. Four incidental simple hepatic cysts are present, measuring 7, 11, 12, and 32 mm.
Case Discussion
When evaluating a pancreatic neuroendocrine tumor (PNET) using CT (computed tomography) imaging, there are several key characteristics and findings that radiologists look for:
Location: PNETs can occur anywhere in the pancreas. They may be localized within the pancreas or involve adjacent structures.
Size: CT can determine the size of the tumor, which is an important factor in assessing its potential malignancy. Larger tumors are more likely to be malignant.
Enhancement: PNETs often enhance (become brighter) on contrast-enhanced CT scans due to their blood supply. The degree of enhancement can vary, and it can help differentiate them from other types of pancreatic tumors.
Calcifications: Some PNETs may have calcifications, which can be visualized on CT scans as small, bright spots within the tumor.
Cystic changes: PNETs can occasionally contain cystic components, which may appear as fluid-filled areas on CT scans.
Vascular invasion: In cases of more aggressive PNETs, CT may reveal evidence of vascular invasion, where the tumor has invaded nearby blood vessels. This is a sign of malignancy.
Metastasis: CT is essential for detecting any potential metastasis to other organs, such as the liver or lymph nodes. PNETs have a propensity to metastasize.
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