Pancreatic neuroendocrine tumor

Case contributed by Dr Bruno Di Muzio

Presentation

History of cirrhosis. Incidental pancreatic lesion.

Patient Data

Age: 70 years
Gender: Male
CT

Liver

Cirrhotic liver. Small subcapsular segment VII cyst.  Otherwise, no suspicious enhancing lesion or washout is demonstrated.
The portal and hepatic veins are patent. Gastric and gastro-esophageal varices are identified, more prominent in the gastric component.  There is a connection with the left renal vein, which appears dilated.

In the distal tip of the pancreatic tail, a rounded 12 mm enhancing lesion is identified.  The enhancement is more prominent than the surrounding pancreatic or splenic parenchyma.  There is no evidence of associated calcification or washout.
A few small bilateral renal cysts are noted. The solid abdominal organs are otherwise normal.
Multiple diverticula are demonstrated in the distal large bowel.  The bowel loops are otherwise normal. No free fluid or enlarged lymph nodes are demonstrated.

Nuclear medicine

Ga-68 DOTATATE

Intense Gatate uptake is seen in the 12 mm pancreatic tail lesion (Krenning score 4)
No Gatate avid retroperitoneal nodes.
Pancreatic uncinated activity is likely physiological.
Mild bilateral inguinal and right pulmonary hilar nodes are likely reactive.

No further areas of abnormal Gatate uptake.

Nuclear medicine

Red Blood Cell Study

There is no uptake of denatured RBC in the tip of the pancreatic tail, in the location of the DOTATATE avid lesion. Diffuse radiotracer uptake in the spleen and heart is physiologic.

 

Annotated image

Summary of the findings supporting pNET over splenunculus. 

Case Discussion

Incidental tail of the pancreas neuroendocrine tumor. The main differential of a hypervascular small nodule at this location is a splenunculus, which sometimes can be adjacent to the pancreas or even intrapancreatic. Although the pattern of enhancement seen on CT is different from that of the spleen, favoring pNET over splenunculus, further nuclear medicine workup and staging has been performed to confidently confirm the diagnosis. 

PlayAdd to Share

Case information

rID: 62854
Published: 13th Jun 2020
Last edited: 15th Jun 2020
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.