Answer for BIR CoW 23 July 2023
Solid Pseudopaillary neoplasm of Pancreas
Findings
Evidence of large well-defined encapsulated T1,T2 –heterointense lesion probably seen arising from head and uncinate process of pancreas with peripheral patchy rim areas of diffusion restriction with low ADC values. The above lesion causes mass effect in the form of compression of IVC and displaces SMA and SMV medially and right kidney posteriorly. On contrast administration,the lesion shows heterogenous enhancement predominantly in the periphery of the lesion.
Impression
Large well-defined encapsulated heterogeneously enhancing T1,T2 heterointense lesion with peripheral patchy rim areas of restricted diffusion probably arising from pancreas-P/O Solid pseudopapillary tumour of pancreas. Solid papillary tumour (SPT) is an uncommon exocrine pancreatic neoplasm first described by Frantz. After the World Health Organization (WHO) reclassification, SPT is now classified as an epithelial tumour under the “Borderline (Uncertain Malignant Potential)” . About 90% of cases involve females, with the mean age of patients being in their third decade of life. The most common presenting symptom is abdominal pain followed by upper abdominal mass. The tumour typically appears as a mixed-density lesion with solid component peripherally and cystic component more centrally. Larger tumours tend to be well-encapsulated with sharp demarcation from the normal pancreas. On contrast-enhanced studies, the capsule and solid portion of SPT will enhance similar to normal pancreatic parenchyma in both arterial and venous phases, vs pancreatic adenocarcinoma that is hypoattenuating in the venous phase and neuroendocrine tumours that are hyperattenuating in the arterial phase . In MRI, typically, lesions have variable signal intensity on T1 weighted images, high signal intensity on T2 weighted images and a hypointense rim on both T1 and T2 weighted images. On post-gadolinium images, lesions demonstrate heterogeneous peripheral enhancement .Compared with the lesion, the surrounding capsule tends to enhance earlier and more intensely. The lesion is classified as solid pseudopapillary carcinoma (SPC) if malignant behaviour such as perineural invasion, angioinvasion or deep invasion of surrounding tissue is seen. Complete resection is associated with long-term survival even in the presence of metastatic disease
References
1. Frantz VK. Tumors of the pancreas. In: Atlas of tumor pathology, section VII, fascicles 27 and 28. Washington, DC: US Armed Forces Institute of Pathology; 1959 2. Papavramidis T, Papavramidis S. Solid pseudopapillary tumours of the pancreas: review of 718 patients reported in english literature. J Am Coll Surg 2005;200:965–72 3. Adams AL, Siegal GP, Jhala NC. Solid pseudopapillary tumour of the pancreas: a review of salient clinical and pathologic features. Adv Anat Pathol 2008;15:39–45.
Findings
Evidence of large well-defined encapsulated T1,T2 –heterointense lesion probably seen arising from head and uncinate process of pancreas with peripheral patchy rim areas of diffusion restriction with low ADC values. The above lesion causes mass effect in the form of compression of IVC and displaces SMA and SMV medially and right kidney posteriorly. On contrast administration,the lesion shows heterogenous enhancement predominantly in the periphery of the lesion.
Impression
Large well-defined encapsulated heterogeneously enhancing T1,T2 heterointense lesion with peripheral patchy rim areas of restricted diffusion probably arising from pancreas-P/O Solid pseudopapillary tumour of pancreas. Solid papillary tumour (SPT) is an uncommon exocrine pancreatic neoplasm first described by Frantz. After the World Health Organization (WHO) reclassification, SPT is now classified as an epithelial tumour under the “Borderline (Uncertain Malignant Potential)” . About 90% of cases involve females, with the mean age of patients being in their third decade of life. The most common presenting symptom is abdominal pain followed by upper abdominal mass. The tumour typically appears as a mixed-density lesion with solid component peripherally and cystic component more centrally. Larger tumours tend to be well-encapsulated with sharp demarcation from the normal pancreas. On contrast-enhanced studies, the capsule and solid portion of SPT will enhance similar to normal pancreatic parenchyma in both arterial and venous phases, vs pancreatic adenocarcinoma that is hypoattenuating in the venous phase and neuroendocrine tumours that are hyperattenuating in the arterial phase . In MRI, typically, lesions have variable signal intensity on T1 weighted images, high signal intensity on T2 weighted images and a hypointense rim on both T1 and T2 weighted images. On post-gadolinium images, lesions demonstrate heterogeneous peripheral enhancement .Compared with the lesion, the surrounding capsule tends to enhance earlier and more intensely. The lesion is classified as solid pseudopapillary carcinoma (SPC) if malignant behaviour such as perineural invasion, angioinvasion or deep invasion of surrounding tissue is seen. Complete resection is associated with long-term survival even in the presence of metastatic disease
References
1. Frantz VK. Tumors of the pancreas. In: Atlas of tumor pathology, section VII, fascicles 27 and 28. Washington, DC: US Armed Forces Institute of Pathology; 1959 2. Papavramidis T, Papavramidis S. Solid pseudopapillary tumours of the pancreas: review of 718 patients reported in english literature. J Am Coll Surg 2005;200:965–72 3. Adams AL, Siegal GP, Jhala NC. Solid pseudopapillary tumour of the pancreas: a review of salient clinical and pathologic features. Adv Anat Pathol 2008;15:39–45.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!