Presentation
Abdominal pain.
Patient Data
A well-defined heterogeneous pancreatic body mass with intense peripheral enhancement and central degeneration with clear perilesional fat and no evident of mesenteric vessel encasement.
Mildly enlarged cirrhotic liver with multiple focal lesions seen scattered through the left and right lobes and showing ring enhancement.
Large volume ascites.
Case Discussion
No biliary obstruction - this is a classic mode of presentation for pancreatic adenocarcinomas.
Neuroendocrine tumors can occasionally manifest as primarily cystic lesions and are distinguishable from other cystic neoplasms by their hypervascular rim as in this case.
75% of patients with neuroendocrine tumors have metastatic disease at presentation, most commonly in the liver and less frequently in bone as in our case.