Presentation
Progressively worsening abdominal pain. Associated with weight loss secondary to poor appetite.
Patient Data
Immediately inferior to or arising from the head of the pancreas, there is an indeterminant well-circumscribed hypoechoic lesion. There is no discernible vascularity centrally.
A round mass is present in the uncinate process of the pancreas. The mass is mildly hypodense compared to normal pancreatic parenchyma. The main pancreatic duct is not dilated.
There is a lesion in the uncinate process of the pancreas that is well-circumscribed and demonstrates heterogeneous and predominantly increased T2 and decreased T1 signal. There is no main ductal dilatation. The main duct traverses just superiorly and right lateral into the lesion. There is no definitive communication between the duct at the lesion.
Case Discussion
This is a case of solid pseudopapillary epithelial neoplasm of the pancreas.
The mass was incidentally noted on ultrasound, which prompted further investigation with CT and MRI. The patient underwent a fine needle biopsy via endoscopic ultrasound. Immunohistochemical analysis revealed that the neoplastic cells were positive for beta-catenin (nuclear staining) and progesterone receptor, and were negative for cytokeratin AE1/AE3, chromogranin, and synaptophysin. Along with the histologic findings, the immunohistochemistry was consistent with a solid pseudopapillary epithelial neoplasm of the pancreas.
Co-authors:
Christine Cooley, MD
Travis Bevington, MD
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