If they do cause symptoms, it will typically be those related to regional mass effect.
Neurofibromas arise from the elements of peripheral nerves, including Schwann cells.
Histologically, benign spindle cells are present in a myxoid fibrillary matrix. Neurofibromas express S100, but no P53 and limited Ki-67.
- mildly enhancing
- T1: hypointense
- T2: hyperintense
Classic appearance is a "target" with a T2 hypointense core surrounded by a T2 hyperintense ring, similar to neurofibromas elsewhere in the body. The myxoid component of the tumor results in the T2 hyperintensity.
- cystic change, calcification, and hemorrhage may be present
- hypoechoic with posterior through-transmission
Treatment and prognosis
Malignant transformation has been estimated to occur in 7-13% of neurofibromas 2. Because of its location, neurofibromas in the pancreas may be treated conservatively.
pancreatic neuroendocrine tumor
- more common overall
- may have a syndromic presentation
- associated with neurofibromatosis type 2
- will have a different histological appearance
- a mucinous lesion of the pancreas with features suspicious for malignancy
- will have characteristic findings on EUS biochemistry and cytology
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- nonepithelial pancreatic neoplasms
pancreatitis (mnemonic for the causes)
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- haemorrhagic pancreatitis
- revised Atlanta classification of acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
- 1. Manning MA, Srivastava A, Paal EE et-al. Nonepithelial Neoplasms of the Pancreas: Radiologic-Pathologic Correlation, Part 1-Benign Tumors: From the Radiologic Pathology Archives. Radiographics. 2016;36 (1): 123-41. doi:10.1148/rg.2016150212 - Pubmed citation
- 2. Delgado J, Jaramillo D, Ho-Fung V et-al. MRI features of plexiform neurofibromas involving the liver and pancreas in children with neurofibromatosis type 1. Clin Radiol. 2014;69 (6): e280-4. doi:10.1016/j.crad.2014.01.020 - Pubmed citation