Presentation
Chronic epigastric pain.
Patient Data
There is a relatively well-defined ovoid soft tissue mass of the pancreatic head measuring 42 x 40 x 38 mm of low signal on T1, heterogeneous high signal on T2 with areas of cystic/necrotic change and peak contrast enhancement in the early arterial phase and became isointense to the enhancing pancreatic parenchyma on delayed phase. The tumor appears in contact with the SMV and IVC with no vascular invasion.
Hepatic hemangioma of segment 7 is noted.
Two small nodules of the left adrenal gland showing signal dropout on opposed-phase images in keeping with small adenoma.
Case Discussion
MRI features are most consistent with a pancreatic neuroendocrine tumor (pNET), pathologically proved as well-differentiated pNET grade II. There were no other associated neuroendocrine tumors of the parathyroid or pituitary glands.
The small left adrenal adenomas were an incidental finding.