Pancreatic tumors in children: radiologic-pathologic correlation

Long-term functional outcomes of PPPD in children--Nutritional status, pancreatic function, GI function and QOL

PURPOSE

The purpose of this study was to analyze the long-term outcomes, such as nutritional status, pancreatic function, gastrointestinal (GI) function, and quality of life (QOL), in children who underwent pylorus-preserving pancreaticoduodenectomy (PPPD).

METHODS

Between 1992 and 2013, there were 15 children who underwent PPPD at Seoul National University Children's Hospital, and 10 of them participated in this study. A retrospective review of the patients' medical records and follow-up was done. Their nutritional statuses were estimated by height, body weight, weight for age Z-score, body mass index (BMI), and serum protein, albumin levels. The endocrine and exocrine functions of the pancreas were estimated by diabetes mellitus (DM), steatorrhea, and Bristol stool chart. The GI function and QOL were evaluated via questionnaires. The follow-up period ranged from 3 to 18years.

RESULTS

There were no severe growth disturbances, 6 patients experienced mild steatorrhea and 3 showed above the category 6 in Bristol stool chart. All the patients experienced mild GI symptoms. As for the QOL, there were no significant negative answers, except for one patient with DM.

CONCLUSIONS

Almost all the study subjects, who underwent PPPD in their childhood, did not present significant problems except for one patient with DM.

Pancreatic tumors imaging: An update

Currently, ultrasound (US), computed tomography (CT) and Magnetic Resonance imaging (MRI) represent the mainstay in the evaluation of pancreatic solid and cystic tumors affecting pancreas in 80-85% and 10-15% of the cases respectively. Integration of US, CT or MR imaging is essential for an accurate assessment of pancreatic parenchyma, ducts and adjacent soft tissues in order to detect and to stage the tumor, to differentiate solid from cystic lesions and to establish an appropriate treatment. The purpose of this review is to provide an overview of pancreatic tumors and the role of imaging in their diagnosis and management. In order to a prompt and accurate diagnosis and appropriate management of pancreatic lesions, it is crucial for radiologists to know the key findings of the most frequent tumors of the pancreas and the current role of imaging modalities. A multimodality approach is often helpful. If multidetector-row CT (MDCT) is the preferred initial imaging modality in patients with clinical suspicion for pancreatic cancer, multiparametric MRI provides essential information for the detection and characterization of a wide variety of pancreatic lesions and can be used as a problem-solving tool at diagnosis and during follow-up.

Primary Pancreatic Lymphoma Simulating Acute Cholestatic Hepatitis in a 7-Year-Old Child

Primary pancreatic lymphoma in children has been described infrequently in literature, and its acute presentation as cholestatic hepatitis is similarly rare. We report a case of a 7-year-old child with primary pancreatic lymphoma presenting as acute infective hepatitis, leading to delay in correct diagnosis and management.

Beger procedure in a 20-year-old female with solid pseudopapillary tumour of the pancreas

Solid pseudopapillary tumour is a rare indolent neoplasm of the pancreas (< 2% of exocrine pancreatic tumours), which predominantly affects young women at reproductive age, without significant clinical symptoms.

We report a case of a 20-year-old Caucasian female who presented with upper abdominal pain of one-year duration. Ultrasound scans of the abdomen demonstrated enlarged pancreatic head and body containing a poorly separated mass (52 × 41 × 36 mm) with a multi-cystic component 20–24 mm in diameter. Laboratory tests including, tumour markers levels, were normal. She underwent complete resection of the tumour using a Beger procedure. By immunohistochemistry, the case stained strongly for CD10 and CD56 and was negative for cytokeratin-7 (CK-7), synaptophysin and chromogranin A. The proliferation index (Ki-67) was < 1%. The patient is being followed-up and remains healthy.

Imaging features of primary malignant pancreatic tumors in children

OBJECTIVE

The purpose of this article is to describe the sonographic, CT, and MRI features of primary malignant pancreatic tumors of childhood.

CONCLUSION

Most children with a pancreatic tumor present with a solid pseudopapillary tumor that is usually well marginated and has solid and cystic areas surrounded by a fibrous capsule. Pancreatoblastoma is more aggressive than solid pseudopapillary tumor. The imaging features are those of a large heterogeneous tumor. Ductal adenocarcinoma is rare in children and has a poor prognosis.

Radiology of pancreatic neoplasms: An update

Diagnostic imaging is an important tool to evaluate pancreatic neoplasms. We describe the imaging features of pancreatic malignancies and their benign mimics. Accurate detection and staging are essential for ensuring appropriate selection of patients who will benefit from surgery and for preventing unnecessary surgeries in patients with unresectable disease. Ultrasound, multidetector computed tomography with multiplanar reconstruction and magnetic resonance imaging can help to do a correct diagnosis. Radiologists should be aware of the wide variety of anatomic variants and pathologic conditions that may mimic pancreatic neoplasms. The knowledge of the most important characteristic key findings may facilitate the right diagnosis.

Imaging of pediatric pancreatic neoplasms with radiologic-histopathologic correlation

OBJECTIVE

The purpose of this article is to describe the imaging features of pediatric pancreatic tumors with pathologic correlation. Epithelial and nonepithelial lesions are described. Pancreatic imaging protocols, clinical presentation, and management are also detailed.

CONCLUSION

Pancreatic neoplasms are rare in children and vary widely between benign and malignant causes and between cystic and solid lesions. Epithelial tumors are most common and include solid pseudopapillary tumor, pancreatoblastoma, islet cell neoplasms, and cystic lesions.

Imaging features of the less common pancreatic masses

Contrast-enhanced multiphase CT and dynamic gadolinium-enhanced MR have been validated in the literature as outstanding modalities for the evaluation of pancreatic pathology. In addition to the more frequently seen pancreatic adenocarcinoma, neuroendocrine tumors of the pancreas and cystic lesions such as serous and mucinous cystadenomas and IPMNs, a variety of benign and malignant lesions may occur in the pancreas. The purpose of this pictorial essay is to review the imaging findings of a variety of uncommon, benign and malignant, pancreatic neoplasms.

The diagnosis and surgical treatment of pancreatoblastoma in adults: a case series and review of the literature

INTRODUCTION

Pancreatoblastoma is an extremely rare pancreatic neoplasm in adults. The aim of this study is to report our experience with adult pancreatoblastoma as well as review the cases reported in the literature in order to provide guidelines for the management of patients with this rare neoplasm.

METHODS

We have encountered three cases of pancreatoblastoma in adults at our institution in addition to the 30 cases reported to date in literature.

RESULTS

The median age of pancreatoblastoma in adults is 37 years (range, 18-78 years); men and women are similarly affected (male/female = 16/17). The behavior of pancreatoblastoma is clearly that of a malignant neoplasm, with local invasion, recurrence, and metastasis. Among the adult reported cases, at diagnosis or operation, metastasis and/or local invasion was found in 14 of 31 adult patients (46 %) (2 patients had no data) The survival was significantly higher in patients with resected tumor (resection only and resection + adjuvant chemo/radiotherapy) when compared to unresected patients (palliative chemo/radiotherapy and no treatment), (p = 0.008, HR = 0.20).

CONCLUSION

When disease is localized, the treatment of choice is a complete surgical resection. The role of adjuvant chemotherapy or radiotherapy is still unclear based on the very small number of patients treated.

Imaging features of pancreatic tumors in children: 13-year experience at a pediatric tertiary hospital

BACKGROUND

Pancreatic tumors are rare in children, resulting in limited information regarding their frequency and imaging appearances.

OBJECTIVE

To review all pancreatic tumors seen in children over a decade at a large tertiary pediatric institution and to describe multimodality imaging findings.

MATERIALS AND METHODS

We conducted a retrospective review of imaging studies performed in children with pancreatic tumors between January 2000 and December 2012, analyzing imaging features on available US, CT and MR examinations. We reviewed patient charts for clinical features, management and final diagnosis.

RESULTS

We included 23 children in this study. Of these, 12 had solid and papillary epithelial neoplasms (SPEN), 3 had neuroendocrine tumors, 3 had lymphoma, and 1 each had hemangioendothelioma, benign congenital cysts with adipose tissue, dendritic cell sarcoma, metastatic rhabdomyosarcoma, and lipoma. All children with SPEN were teenage girls. SPEN showed characteristic imaging features including well-defined margins with surrounding capsule, solid-cystic components and hemorrhage.

CONCLUSION

Pancreatic tumors are uncommon in children. SPEN is the most common tumor and is seen predominantly in teenage girls and shows characteristic imaging features.

FDG PET/CT findings of solid pseudopapillary tumor of the pancreas with CT and MRI correlation

PURPOSE

The aim of this study was to evaluate retrospectively (18)F-FDG PET/CT findings of solid pseudopapillary tumor of the pancreas (SPTP).

PATIENTS AND METHODS

FDG PET/CT findings were reviewed in 8 patients with SPTP confirmed by pathology. Early PET/CT scans were performed 1 hour after FDG injection in all 8 patients. After an interval of 1 hour, delayed PET/CT scans were performed in 6 patients. All patients underwent enhanced CT and 4 patients underwent MRI.

RESULTS

A total of 8 tumors were detected in all 8 patients. CT and MRI findings included encapsulation (n = 2), solid and cystic components (n = 4), focal calcification (n = 7), and weak enhancement during the arterial phase on enhanced CT or MRI and increasing enhancement during the portal venous phase (n = 8). All the tumors showed increased FDG uptake. The mean SUVmax of all tumors was 8.9, with a high variability of SUVmax among lesions ranging from 2.5 to 29.1. The tumors (n = 6) with high cellularity had stronger FDG uptake, whereas the tumors (n = 2) with low cellularity had relatively low FDG uptake. The tumors (n = 6) with pancreatic parenchymal, vascular, or perineural invasions had intense FDG uptake, whereas the tumors (n = 2) without invasions had slight-to-moderate FDG uptake. Two tumors with relatively high proliferative index had very strong FDG uptake, whereas those (n = 6) with low proliferative index or negative Ki-67 staining result had relatively lower FDG uptake. On delayed FDG PET/CT images, The SUVmax of SPTP increased in 4 patients and slightly decreased in 2 patients.

CONCLUSIONS

CT or MRI demonstrated morphological features of SPTP and FDG PET/CT that reflected the histopathological composition of the tumors. FDG uptake of SPTP may be related to tumor cellularity, proliferative index, or histological malignancy. Familiarity with the morphological and functional imaging findings of SPTP may be helpful for correct diagnosis and appropriate treatment.

Isolated pancreatic tuberculosis: a case report and radiological comparison with cystic pancreatic lesions

Pancreatic tuberculosis is rare and can occur in the absence of evidence of tuberculosis elsewhere in the body. Here we review the radiological appearance of pancreatic tuberculosis and compare it with other cystic pancreatic lesions, including common lesions (pseudocysts, serous or mucinous cystadenomas, intraductal papillary mucinous neoplasm) and rare lesions such as solid pseudopapillary tumors, etc. Their typical localizations within the pancreas and their malignant potential are presented. Knowledge of these can assist radiologists and clinicians in selecting the best approach towards making the correct diagnosis.

Perinatal neuroblastoma of the pancreas

Neuroblastoma is the most common solid tumor in infancy. Arising from the neural crest these tumors are usually located along the sympathetic chain from the neck to the pelvis and in the adrenal medulla. We report the case of a 3-week-old boy presenting with recurrent episodes of colicky pain. After ultrasound examination, magnetic resonance imaging and laboratory data a pancreatic neuroblastoma was suspected. Tumor resection via distal pancreatectomy and histologic investigation confirmed the diagnosis. Surgery is the treatment of choice in children with pancreatic masses, and is usually well tolerated even in the neonatal period. Conclusive diagnosis can be frequently established only by tumor resection or biopsy. Pancreatic neuroblastoma is an extremely rare tumor with only a few cases described in literature.

Clinical analysis of childhood pancreatoblastoma arising from the tail of the pancreas

Pancreatoblastoma is a rare pancreatic tumor. In this study, 3 cases of childhood pancreatoblastoma that arise from the tail of the pancreas were reported. Abdominal pain and vomiting were observed in 1 case considering the huge size of the tumor. The other 2 patients, who were previously well, complained of a mass in the abdomen after a casual physical examination. Elevated serum α-fetoprotein levels were noted in all cases. Imaging findings indicated a well-defined heterogeneous large mass in the left retroperitoneal space. Exploratory laparotomy revealed a large mass, arising from the tail of the pancreas. Surgery alone with complete excision of the masses was performed. Immunohistochemical staining showed that only α-fetoprotein was positive in all cases. All of these 3 cases have a good outcome in the follow-up without adjuvant chemotherapy. These data suggest that the diagnosis of pancreatoblastoma is difficult and should be suspected at palpation of an abdominal mass. α-Fetoprotein may serve as a tumor marker for preoperative diagnosis and postoperative recurrence. Pancreatoblastoma arising from the tail of the pancreas is a curable tumor, and adjuvant chemotherapy may not be necessary if the tumor can be excised completely.

Solid pseudopapillary tumour of the pancreas in children: clinical and computed tomography manifestation

PURPOSE

The purpose of our study was to retrospectively assess imaging features of computed tomography (CT) and clinical characteristics of children with solid pseudopapillary tumours (SPTs) of the pancreas in comparison with those of SPTs in adults.

MATERIALS AND METHODS

CT images and clinical data of 86 patients with histopathologically proven SPTs were reviewed. Eighteen patients were classified as children (≤18 years old), and 68 were classified as adults (>18 years old) according to age at diagnosis. Statistical analysis was performed using the χ (2) test and the Student's t test.

RESULTS

Eighteen patients (15 girls and three boys) were children, with an average age of 15.1 years at operation. Abdominal pain or discomfort was the most common manifestation in children (66.7%). Mean tumour size in children was significantly larger than in adults (9.1 vs. 5.7 cm; p=0.001). Except for tumour size, no significant statistical difference was observed in clinical factors or imaging features between SPTs in children and adults.

CONCLUSIONS

Ours is the largest single-centre study to demonstrate the features of pancreatic SPT in children. SPT diagnosis should always be considered when a large pancreatic mass with typical imaging is found in a child, especially in adolescent girls.

Management of pancreatoblastoma in children and young adults

Pancreatoblastoma is a very rare childhood tumor originating from the epithelial exocrine cells of the pancreas. It is the most common malignant pancreatic tumor in young children and has a mean age of diagnosis of 5 years. It is slow growing and its presentation is varied and often non-specific. Tumors tend to be quite large and appropriate cross sectional imaging is very important to assess for extent, metastatic disease, and resectability. Biopsy for tissue diagnosis is essential. Complete surgical resection is the goal of therapy although many patients are unresectable at initial diagnosis and require neoadjuvant chemotherapy. Adjuvant chemotherapy is also recommended and chemotherapeutic regimens involve cisplatin and doxorubicin. Even with curative resections, these lesions have a high recurrence rate and patients must be followed closely. Knowledge of this rare tumor is important for the clinician confronted with a large retroperitoneal mass in a young child.

Malignant pancreatic tumors in children: a single-institution series

BACKGROUND

Pancreatic tumors in children represent a very rare entity. We reviewed the clinical and pathologic features of pediatric patients with pancreatic tumors at a single institution.

METHODS

We conducted a retrospective review of cases diagnosed at the Hospital for Sick Children between 1986 and 2010.

RESULTS

Twenty-seven patients were diagnosed during the study period: 18 with solid pseudopapillary neoplasm (SPN), 6 with pancreatic endocrine neoplasia, and 3 with other tumors. Of the 27 children, 3 had associated syndromes, in specific tuberous sclerosis, von Hippel-Lindau, and polycystic ovarian syndrome. The most common symptoms were pain and vomiting in SPN and hypoglycemia and seizures in insulinomas. Magnetic resonance imaging and computed tomographic scan were equally accurate in determining size and site of origin of the tumor, and both were better than ultrasound. All patients underwent surgery (distal pancreatectomy in 14 cases, Whipple procedure in 8, other procedures in 5), which represented the only treatment for all but 3 cases. Seventeen patients (94%) with SPN are alive (median follow-up, 32 months), 3 of whom had positive margins. Two patients died: 1 male with SPN with malignant transformation and 1 with fibrosarcoma.

CONCLUSIONS

We describe the largest single-institution study of pediatric pancreatic tumors. Females with SPN have an excellent outcome, even in presence of positive margins, suggesting that limited surgical resection may be appropriate for these patients.

Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas

Solid lesions of the pancreas represent a heterogeneous group of entities that can be broadly classified as either neoplastic or nonneoplastic. Neoplastic lesions include pancreatic adenocarcinoma, pancreatic neuroendocrine tumor, solid pseudopapillary tumor, pancreatoblastoma, pancreatic lymphoma, metastases to the pancreas, and rare miscellaneous neoplasms. Nonneoplastic lesions include focal pancreatitis, fatty infiltration-replacement, intrapancreatic accessory spleen, congenital anomalies such as prominent pancreatic lobulation and bifid pancreatic tail (pancreatic bifidum), and rare miscellaneous lesions (eg, pancreatic sarcoidosis, Castleman disease of the pancreas). A variety of imaging modalities are available for assessing these solid lesions, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging, endoscopic US, and hybrid nuclear imaging techniques such as single photon emission computed tomography-CT and positron emission tomography-CT, each of which has its own strengths and limitations. Accurate diagnosis can be challenging, and use of a multimodality imaging approach is often helpful in equivocal or complex cases. Knowledge of relevant clinical information and key radiologic features is essential for confident lesion characterization and differentiation.

Pancreatic resections for solid or cystic pancreatic masses in children

OBJECTIVES

The aim of the study was to assess the diagnosis and management of solid pancreatic neoplasm in children and the type of surgical treatment, focusing on short- and long-term outcomes.

METHODS

We retrospectively reviewed the charts of all children who had undergone pancreatic resection for suspicion of pancreatic tumor in Kremlin Bicêtre Hospital, Paris, between 1986 and 2008. We studied the symptoms at diagnosis, the type of surgery, and the short- and long-term morbidity and mortality.

RESULTS

Of 18 patients identified, there were 7 pseudopapillary tumors, 3 neuroblastomas, 2 rhabdomyosarcomas, 1 acinar cell carcinoma, 1 endocrine cell carcinoma, 1 renal angiomyolipoma, and 3 pancreatic cysts. Symptoms at diagnosis were abdominal trauma, abdominal mass, and jaundice. Operative procedures were duodenopancreatectomy (11), mid-pancreatic resections (2), splenopancreatectomy (2), distal pancreatectomy (1), and tumorectomy (2). There were no deaths related to surgery. The postoperative morbidity rate was 45%, including 2 cases of fistula (11%) occurring after a mid-pancreatic resection and a pancreaticoduodenectomy. The median follow-up was 4.2 years (range 2-11). There was no diabetes mellitus, but there was 1 case of fat diet intolerance requiring pancreatic enzyme substitution. All of the children had a growth curve within normal limits.

CONCLUSIONS

In this experience, pancreatic resections have proven to be a safe and efficient procedure, with low long-term morbidity, for the treatment of tumoral and selected nontumoral pancreatic masses.

Case report. Unusual presentation of a pancreatic mass in an infant: pancreatic haemangioendotheliomatosis

Primary pancreatic tumours are extremely rare in children. We report a case of a 5-month-old male with a diffuse invasive tumour of the head of the pancreas. The tumour demonstrated peripancreatic extension into the porta hepatis, which occluded the portal vein and invaded the superior mesenteric artery. It was found to be haemangioendotheliomatosis of the pancreas. Imaging, pathological findings and a brief relevant classification of haemangioma are discussed.

Gastrointestinal tumors in children

Although tumors arising from the spleen, pancreas, and gastrointestinal tract in the pediatric population are relatively uncommon, imaging plays an important role in diagnosis, staging, and treatment planning. Initial imaging with abdominal radiograph contributes to the evaluation for intestinal obstruction, constipation, and mass effect, and sometimes may reveal areas of calcification.

Pancreatic cystic lesion in an infant

Pancreatic cystic lesions are rare clinical entities. To the best of our knowledge, only 38 cases have been reported in the English literature in children under the age of 2 years. We present a 2-month-old infant with a cystic lesion in the head of pancreas. We reviewed the possible causes and present our dilemmas in the management of these patients.

Solid pseudopapillary tumor of the pancreas: a rare and probably misdiagnosed neoplasm

Solid Pseudopapillary Tumor of the pancreas is a rare nonfunctioning tumor. It is considered a low-grade malignancy that is apparently curable with surgical complete excision in most instances. We present a case of solid pseudopapillary pancreatic tumor that represented a challenge to the radiologists. This case highlights its possible various appearances and the need to the radiologist to be familiar with them.

Synchronous ectopic pancreatoblastoma in a child: a case report

Pancreatoblastoma is a rare primary pancreatic neoplasm of children that may arise in any portion of the pancreas. We report a case of a 3-yr-old boy who presented to with abdominal pain our hospital and a progressive bulge in his right abdomen. Biochemical evaluation and serum levels of tumoral markers were within reference limits. On the computed tomography, two tumors were found. One located in the head of the pancreas; however, a laparotomy revealed that the head of pancreas was compressed but normal. The other was in the left abdomen near the spleen and the tail of the pancreas. The diagnosis of two synchronous pancreatoblastoma originating from the omentum was confirmed by pathology. Therefore, a pancreatoblastoma should be considered when a large well-defined, lobulated, and heterogeneous mass is identified in the pancreas of children. In addition, an ectopic pancreatoblastoma should be considered when identified within or near the ectopic pancreatic tissue.

Imaging findings of pancreatoblastoma in 4 children including a case of ectopic pancreatoblastoma

BACKGROUND

Pancreatoblastoma is a rare primary pancreatic neoplasm of children. The tumour may arise from any portion of the pancreas, but no tumour originating from ectopic pancreatic tissue has been reported in the English medical literature.

OBJECTIVE

We report the radiological findings of pancreatoblastoma in four children, including one tumour originating from the mesentery, to our knowledge, reported for the first time.

MATERIALS AND METHODS

Four children with pancreatoblastoma were identified at our hospital between 2000 and 2007. US and CT were performed in all children, with MR performed in two. Various CT and MRI features were evaluated including size, organ of origin, definition and quality of tumour margins, heterogeneity and attenuation of the mass, calcification, presence of ascites, adenopathy, metastases, and signal intensity on MR images. Complete excision was performed in all children. The diagnosis of pancreatoblastoma was confirmed with histopathological results.

RESULTS

Our cases displayed some typical and atypical features of pancreatoblastoma. The findings of our series suggest that the majority of these tumours are large, heterogeneous and of low to intermediate signal intensity on T1-W images and high signal intensity on T2-W images. Calcifications were common on CT. All of the tumours had heterogeneous enhancement on CT and MR images.

CONCLUSION

Pancreatoblastoma is a rare primary tumour of the pancreas. When a large mass is identified in the pancreas in children that is heterogeneous in nature with internal calcifications, the diagnosis should be considered.

Small (<or=3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT

PURPOSE

To analyze the imaging features of small (≤3 cm) solid pseudopapillary tumors (SPTs) seen at multiphasic multidetector computed tomography (CT) in comparison with those of larger SPTs.

MATERIALS AND METHODS

This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. CT images of 42 histopathologically proven SPTs in the pancreas were retrospectively reviewed. Two radiologists in consensus analyzed the CT findings for the shape, location, diameter, ratio of solid-to-cystic components, border and margin, enhancement pattern, and enhancement grade of the tumors, as well as the presence of calcification, dilatation of the pancreatic duct, and parenchymal atrophy. Then, according to the feature analysis results, the reviewers classified all SPTs as typical or atypical; they also subdivided all SPTs into small (≤3 cm) and large SPTs (>3 cm) depending on the tumor size. Differences in the morphologic features between small SPTs and large typical and atypical SPTs were statistically evaluated by using the Fisher exact test; differences in attenuation between the pre- and postcontrast images and in the dynamic enhancement pattern according to nodule size (≤3 cm versus >3 cm) were evaluated by using the χ(2) test or Fisher exact test for categorical variables.

RESULTS

There were 20 typical SPTs and 22 atypical SPTs. Of the 22 atypical SPTs, 12 (54%) were 3 cm or smaller in diameter and 10 (45%) were larger than 3 cm in diameter. Small atypical SPTs usually appeared as solid tumors with a sharp margin and without accompanying pancreatic duct dilatation or parenchymal atrophy. They also showed weak enhancement during the pancreatic phase and a gradually increasing enhancement pattern. All typical SPTs were larger than 3 cm and appeared as well-defined cystic and solid masses with heterogeneous enhancement, while all large atypical SPTs appeared as calcified solid masses or large cystic masses.

CONCLUSION

The imaging features of small SPTs are different from those of large SPTs, and small SPTs frequently appear as purely solid tumors with a sharp margin and gradual enhancement.

Solid pseudopapillary tumor of the pancreas in children: typical radiological findings and pathological correlation

We report a case series of three children with solid pseudopapillary tumor of the pancreas (SPT) in which a complete radiological work-up, including ultrasound, computed tomography scans, and MRI, has been carried out. The aim of this article is to highlight the characteristic imaging findings of SPT in the pediatric age group and to establish a correlation with typical histopathological findings of the lesion.

Pancreatic disease in children and adolescents

Many childhood pancreatic disorders are rare, although they can represent significant and potentially severe disease. The spectrum of disease is very broad, ranging from the complex and bizarre congenital anomalies to the more typical acquired causes (e.g., drug-induced pancreatitis or trauma injury). Genetics appears to play a major role in many childhood pancreas diseases, unlike adults where alcohol is a major factor. Nevertheless, there are similarities, and most of the disorders discussed here can be found in both the pediatric and adult age groups. Some of these disorders may be evolving and may be seen in both young and older patients. Newer imaging modalities and therapeutic endoscopy continue to be studied, although their ultimate role and utility in children has yet to be fully elucidated.

Malignant Nonfunctioning Neuroendocrine Neoplasm of the Pancreas in a 10-Year-Old Child

Malignant neoplasms of the pancreas are extremely rare in children and only represent a small percentage of pediatric cancer-related deaths. The paucity of cases reported in the literature, in addition to the lack of understanding of biologic behavior, has led to a lack of consensus concerning optimal management strategy. Presentation differs compared to adult counterparts and generally prognosis is improved even when lymph node metastases occur. Here we review the literature and report the case of a 10-year-old autistic female with a malignant nonfunctioning pancreatic endocrine neoplasm of the head of the pancreas successfully extirpated via pancreaticoduodenectomy.

Imaging of the unusual pediatric 'blastomas'

‘Blastomas’ are tumors virtually unique to childhood. Controversy surrounds their nomenclature and there is no globally accepted classification. They are thought to arise from immature, primitive tissues that present persistent embryonal elements on histology, affect a younger pediatric population and are usually malignant. The ‘commoner’ blastomas (neuroblastoma, nephroblastoma, hepatoblastoma, medulloblastoma) account for approximately 25% of solid tumors in the pediatric age range. We present examples of the more unusual blastematous pediatric tumors (lipoblastoma, osteoblastoma, chondroblastoma, hemangioblastoma, gonadoblastoma, sialoblastoma, pleuropulmonary blastoma, pancreatoblastoma, pineoblastoma, and medullomyoblastoma) that were recorded in our institution. Although these rare types of blastomas individually account for <1% of pediatric malignancies, collectively they may be responsible for up to 5% of pediatric tumors in a given population of young children. Imaging is often non-specific but plays an important role in their identification, management and follow-up. Some characteristic imaging features at diagnosis, encountered in cases diagnosed and treated in our institution, are described and reviewed.

Pancreatoblastoma In A Six-Month-Old Child

The case of a six-month-old child with pancreatoblastoma is presented. Pancreatoblastoma is a rare primary neoplasm of childhood, usually presenting in children ranging from 2 −8 years old. The radiologic findings vary from solid to complex masses. This case is unusual due to the young age of the patient.

Malignant pancreatic tumors: incidence and outcome in 58 pediatric patients

OBJECTIVE

The purpose of the study was to examine current incidence trends and outcomes for children with pancreatic malignancies.

METHODS

The Surveillance, Epidemiology, and End Results registry (1973-2004) was examined for pediatric patients with pancreatic malignancies (up to 19 years of age).

RESULTS

Malignant pancreatic neoplasms were identified in 58 patients. Females outnumbered males 1.9 to 1 (38 vs 20) for an age population-adjusted incidence of 0.021 and 0.015 per 100,000. Overall, 70% (n = 41) of patients were white. Asians had the highest incidence. Tumors were classified as exocrine (n = 31, 53.4%), endocrine (n = 19, 32.8%), or sarcomas (n = 5, 8.6%). Exocrine tumors included pancreatoblastoma (n = 10), solid-cystic tumor (SCT) (n = 10), ductal adenocarcinoma (DA) (n = 7), and acinar cell carcinoma (ACC) (n = 4). All SCTs and 80% of pancreatoblastomas were seen in females, whereas males had a higher incidence of DA 71% (P = .036). Ductal adenocarcinoma, SCT, acinar cell carcinoma, sarcomas, and endocrine tumors were more common in children older than 10 years, whereas pancreatoblastoma was more common in younger children (P = .045). Almost half of patients (n = 25) presented with distant metastasis; of these, 44% were endocrine tumors. Survival was significantly greater for female patients (P = .004) and for those who had surgery (P = .001) by both univariate and multivariate analysis. There was a significant difference in tumor type 15-year survival with DA having the worst (23%) and SCT the best (100%).

CONCLUSIONS

Pediatric pancreatic neoplasms are uncommon and carry a variable prognosis. Both female sex and surgery were independent predictors of improved survival.

F-18 fluorodeoxyglucose uptake in a solid pseudopapillary tumor of the pancreas mimicking malignancy

Solid pseudopapillary tumors (SPTs), predominantly affecting young women, are rare pancreatic tumors. It is reported that imaging features of SPT are solid and cystic components, and there is intratumoral hemorrhage and calcification. However, findings of positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) with pathologic correlation have not been fully evaluated. We present a case of SPT that mimicked malignancy on FDG-PET.

Carcinoid tumors of the pancreas: dynamic CT and MRI features with pathological correlation

BACKGROUND

Carcinoid tumor of the pancreas is rare, and there are few reports that described its CT or magnetic resonance imaging (MRI) findings. We describe the characteristic CT and MRI findings in four cases of carcinoid tumor of the pancreas.

METHODS

Radiologic and pathologic features were analyzed in four patients. All patients underwent triple-phase dynamic CT and MRI.

RESULTS

The tumor size in the four cases ranged 15-20 mm and intratumoral calcification was detected in one case. On triple-phase dynamic CT, the peak enhancement of the tumors was seen at the arterial dominant phase in three cases; the remaining one was at the portal venous phase with prolonged contrast-enhancement effect. The tumors showed low to high signal intensity on T2-weighted images. Dilatation of the main pancreatic ducts (MPDs) distal to the tumors was seen in three cases, in which tumor invasion into the MPDs was pathologically confirmed. Furthermore, the tumors having mild to severe fibrosis pathologically invaded into the peripancreatic lymphatics or nerves.

CONCLUSION

It would be characteristic of carcinoid tumor of the pancreas to be well enhanced at the arterial dominant phase on dynamic CT, and to highly invade into the MPDs and the peripancreatic lymphatics or nerves.

Multicystic adenomatoid hamartoma of the pancreas: a hitherto undescribed pancreatic tumor occurring in a 3-year-old boy

This report describes an unusual pancreatic tumor in a 3-year-old boy. He presented with abdominal pain secondary to pancreatitis and was found to have a complex, multicystic lesion within the head of the pancreas. He subsequently underwent a pancreatoduodenectomy. Grossly, the mass was 3 cm, multicystic, and well demarcated. Histologically, there were numerous variably sized, dilated ducts lined by tall columnar mucinous cells surrounded by a stroma that exhibited foci of cellular condensations resembling primitive pancreatic mesenchyme. Acinar and endocrine cells were often seen budding into the ducts forming "ductulo-insular bodies." As a result of its superficial resemblance to Stocker type 2 cystic adenomatoid malformation of the lung, we are proposing the name "multicystic adenomatoid hamartoma" for this lesion.

Wilms' tumor, pancreatic islet cell carcinoma, and pheochromocytoma in a child

We present the first case of Wilms' tumor, pancreatic islet cell carcinoma, and pheochromocytoma affecting the same individual. This case underscores the importance of repeat biopsies in patients with multiple neoplasms to confirm the diagnosis and guide management.

Sporadically occurring functional pancreatic endocrine tumors: review of recent literature

PURPOSE OF REVIEW

Pancreatic neuroendocrine tumors are rare neoplasms often associated with a clinical syndrome. Their rarity makes a comprehensive study difficult at any single institution, while their uniqueness makes them desirable for investigation. This review summarizes recent information and advancements concerning pancreatic neuroendocrine tumor diagnosis, imaging characteristics, treatment algorithms, and staging.

RECENT FINDINGS

Insulinomas and gastrinomas comprise the majority of functional pancreatic neuroendocrine tumors. Advances in their identification and diagnostic evaluation, imaging techniques, and treatment algorithms are presented. Furthermore, a new staging classification system has been proposed which may significantly improve the ability to conduct future multi-institutional investigations on pancreatic neuroendocrine tumors.

SUMMARY

Although rare, a thorough understanding of pancreatic neuroendocrine tumors is essential for all physicians due to the wide variety of symptoms with which patients present. Currently, patients are often misdiagnosed for extended periods of time. This review summarizes the recently published literature about diagnosis, imaging, treatment, and staging of pancreatic neuroendocrine tumors.

Uncommon solid pancreatic neoplasms: ultrasound, computed tomography, and magnetic resonance imaging features

This article reviews the ultrasound, computed tomography, and magnetic resonance imaging features of rare solid tumors of the pancreas with attention to distinctive imaging appearances, which can help radiologists to discriminate between the different entities. Various uncommon solid pancreatic neoplasms, including exocrine and endocrine epithelial tumors, mesenchymal tumors, and metastases, are reviewed, with emphasis on key differential points, including morphologic features and patterns of contrast enhancement.

MR imaging appearance of insulinoma in an infant

Insulinoma is a very rare pancreatic neoplasm of childhood. Early recognition of insulinoma is important to ensure proper surgical treatment and prevent serious adverse neurological consequences. We describe here a case of insulinoma in an infant who presented with seizures and abnormal behaviour. Random blood glucose was found to be abnormally low (40 mg/dl). MRI showed a well-encapsulated mass (hypointense on T1-weighted and hyperintense on T2-weighted images) at the junction of the head and body of the pancreas. The tumour was successfully enucleated. Histopathology confirmed the diagnosis of insulinoma.