Abdominal Imaging

, Volume 38, Issue 4, pp 802–817 | Cite as

Vascular pancreatic lesions: spectrum of imaging findings of malignant masses and mimics with pathologic correlation

  • Priya R. Bhosale
  • Christine O. Menias
  • Aparna Balachandran
  • Eric P. Tamm
  • Chusilp Charnsangavej
  • Isaac R. Francis
  • Khaled M. Elsayes


The differential diagnosis of hypervascular pancreatic lesions is complex, and includes endocrine and exocrine tumors of the pancreas, metastases to the pancreas, and masses, or mass-like lesions, arising from the neurovascular networks traversing the pancreas. In this manuscript, we will discuss salient imaging findings of these masses, pertinent differential diagnoses, as well as review clinical symptomatology that may aid in the diagnosis of some of these lesions.


Pancreas Endocrine Exocrine Metastatic Hypervascular Imaging 


  1. 1.
    Yao JC, Eisner MP, Leary C, et al. (2007) Population-based study of islet cell carcinoma. Ann Surg Oncol 14:3492–3500PubMedCrossRefGoogle Scholar
  2. 2.
    Asa SL (2011) Pancreatic endocrine tumors. Mod Pathol 24(Suppl 2):S66–S77PubMedCrossRefGoogle Scholar
  3. 3.
    Kloppel G (2007) Tumour biology and histopathology of neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab 21:15–31PubMedCrossRefGoogle Scholar
  4. 4.
    Vortmeyer AO, Huang S, Lubensky I, Zhuang Z (2004) Non-islet origin of pancreatic islet cell tumors. J Clin Endocrinol Metab 89:1934–1938PubMedCrossRefGoogle Scholar
  5. 5.
    Oberg K (2010) Pancreatic endocrine tumors. Semin Oncol 37:594–618PubMedCrossRefGoogle Scholar
  6. 6.
    Rindi G, Bordi C (2005) Endocrine tumours of the gastrointestinal tract: aetiology, molecular pathogenesis and genetics. Best Pract Res Clin Gastroenterol 19:519–534PubMedCrossRefGoogle Scholar
  7. 7.
    Franko J, Feng W, Yip L, Genovese E, Moser AJ (2010) Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2,158 patients. J Gastrointest Surg 14:541–548PubMedCrossRefGoogle Scholar
  8. 8.
    Scarpa A, Mantovani W, Capelli P, et al. (2010) Pancreatic endocrine tumors: improved TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients. Mod Pathol 23:824–833PubMedCrossRefGoogle Scholar
  9. 9.
    Rindi G, Kloppel G, Alhman H, et al. (2006) TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 449:395–401PubMedCrossRefGoogle Scholar
  10. 10.
    Oberg K, Eriksson B (2005) Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol 19:753–781PubMedCrossRefGoogle Scholar
  11. 11.
    Zhao Y, Wang X, Yang B, et al. (2000) Pancreatic insulinomas: experience in 220 patients. Zhonghua Wai Ke Za Zhi 38:10–13PubMedGoogle Scholar
  12. 12.
    Guettier JM, Gorden P (2010) Insulin secretion and insulin-producing tumors. Expert Rev Endocrinol Metab 5:217–227PubMedCrossRefGoogle Scholar
  13. 13.
    Service FJ, McMahon MM, O’Brien PC, Ballard DJ (1991) Functioning insulinoma–incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 66:711–719PubMedCrossRefGoogle Scholar
  14. 14.
    Hirshberg B, Livi A, Bartlett DL, et al. (2000) Forty-eight-hour fast: the diagnostic test for insulinoma. J Clin Endocrinol Metab 85:3222–3226PubMedCrossRefGoogle Scholar
  15. 15.
    Wilcox CM, Seay T, Arcury JT, Mohnen J, Hirschowitz BI (2011) Zollinger–Ellison syndrome: presentation, response to therapy, and outcome. Dig Liver Dis 43:439–443PubMedCrossRefGoogle Scholar
  16. 16.
    Ellison EC, Sparks J, Verducci JS, et al. (2006) 50-year appraisal of gastrinoma: recommendations for staging and treatment. J Am Coll Surg 202:897–905PubMedCrossRefGoogle Scholar
  17. 17.
    Mansour JC, Chen H (2004) Pancreatic endocrine tumors. J Surg Res 120:139–161PubMedCrossRefGoogle Scholar
  18. 18.
    Stabile BE, Morrow DJ, Passaro E Jr (1984) The gastrinoma triangle: operative implications. Am J Surg 147:25–31PubMedCrossRefGoogle Scholar
  19. 19.
    Gibril F, Schumann M, Pace A, Jensen RT (2004) Multiple endocrine neoplasia type 1 and Zollinger–Ellison syndrome: a prospective study of 107 cases and comparison with 1009 cases from the literature. Medicine (Baltimore) 83:43–83CrossRefGoogle Scholar
  20. 20.
    Jensen RT, Berna MJ, Bingham DB, Norton JA (2008) Inherited pancreatic endocrine tumor syndromes: advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer 113:1807–1843PubMedCrossRefGoogle Scholar
  21. 21.
    Kwekkeboom DJ, de Herder WW, Kam BL, et al. (2008) Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0, Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol 26:2124–2130PubMedCrossRefGoogle Scholar
  22. 22.
    Eldor R, Glaser B, Fraenkel M, et al. (2011) Glucagonoma and the glucagonoma syndrome—cumulative experience with an elusive endocrine tumour. Clin Endocrinol (Oxf) 74:593–598CrossRefGoogle Scholar
  23. 23.
    Ghaferi AA, Chojnacki KA, Long WD, Cameron JL, Yeo CJ (2008) Pancreatic VIPomas: subject review and one institutional experience. J Gastrointest Surg 12:382–393PubMedCrossRefGoogle Scholar
  24. 24.
    Capella C, Polak JM, Buffa R, et al. (1983) Morphologic patterns and diagnostic criteria of VIP-producing endocrine tumors. A histologic, histochemical, ultrastructural, and biochemical study of 32 cases. Cancer 52:1860–1874PubMedCrossRefGoogle Scholar
  25. 25.
    Nesi G, Marcucci T, Rubio CA, Brandi ML, Tonelli F (2008) Somatostatinoma: clinico-pathological features of three cases and literature reviewed. J Gastroenterol Hepatol 23:521–526PubMedCrossRefGoogle Scholar
  26. 26.
    Fendrich V, Ramaswamy A, Slater EP, Bartsch DK (2004) Duodenal somatostatinoma associated with Von Recklinghausen’s disease. J Hepatobiliary Pancreat Surg 11:417–421PubMedCrossRefGoogle Scholar
  27. 27.
    O’Grady HL, Conlon KC (2008) Pancreatic neuroendocrine tumours. Eur J Surg Oncol 34:324–332PubMedCrossRefGoogle Scholar
  28. 28.
    Adams AL, Siegal GP, Jhala NC (2008) Solid pseudopapillary tumor of the pancreas: a review of salient clinical and pathologic features. Adv Anat Pathol 15:39–45PubMedCrossRefGoogle Scholar
  29. 29.
    Faraj W, Jamali F, Khalifeh M, Hashash J, Akel S (2006) Solid pseudopapillary neoplasm of the pancreas in a 12-year-old female: case report and review of the literature. Eur J Pediatr Surg 16:358–361PubMedCrossRefGoogle Scholar
  30. 30.
    Choi SH, Kim SM, Oh JT, et al. (2006) Solid pseudopapillary tumor of the pancreas: a multicenter study of 23 pediatric cases. J Pediatr Surg 41:1992–1995PubMedCrossRefGoogle Scholar
  31. 31.
    Chung YE, Kim MJ, Choi JY, et al. (2009) Differentiation of benign and malignant solid pseudopapillary neoplasms of the pancreas. J Comput Assist Tomogr 33:689–694PubMedCrossRefGoogle Scholar
  32. 32.
    Tipton SG, Smyrk TC, Sarr MG, Thompson GB (2006) Malignant potential of solid pseudopapillary neoplasm of the pancreas. Br J Surg 93:733–737PubMedCrossRefGoogle Scholar
  33. 33.
    Chen J, Baithun SI (1985) Morphological study of 391 cases of exocrine pancreatic tumours with special reference to the classification of exocrine pancreatic carcinoma. J Pathol 146:17–29PubMedCrossRefGoogle Scholar
  34. 34.
    Ordonez NG (2001) Pancreatic acinar cell carcinoma. Adv Anat Pathol 8:144–159PubMedCrossRefGoogle Scholar
  35. 35.
    Schmidt CM, Matos JM, Bentrem DJ, et al. (2008) Acinar cell carcinoma of the pancreas in the United States: prognostic factors and comparison to ductal adenocarcinoma. J Gastrointest Surg 12:2078–2086PubMedCrossRefGoogle Scholar
  36. 36.
    Klimstra DS, Heffess CS, Oertel JE, Rosai J (1992) Acinar cell carcinoma of the pancreas. A clinicopathologic study of 28 cases. Am J Surg Pathol 16:815–837PubMedCrossRefGoogle Scholar
  37. 37.
    Morohoshi T, Kanda M, Horie A, et al. (1987) Immunocytochemical markers of uncommon pancreatic tumors. Acinar cell carcinoma, pancreatoblastoma, and solid cystic (papillary-cystic) tumor. Cancer 59:739–747PubMedCrossRefGoogle Scholar
  38. 38.
    Caruso RA, Inferrera A, Tuccari G, Barresi G (1994) Acinar cell carcinoma of the pancreas. A histologic, immunocytochemical and ultrastructural study. Histol Histopathol 9:53–58PubMedGoogle Scholar
  39. 39.
    Holen KD, Klimstra DS, Hummer A, et al. (2002) Clinical characteristics and outcomes from an institutional series of acinar cell carcinoma of the pancreas and related tumors. J Clin Oncol 20:4673–4678PubMedCrossRefGoogle Scholar
  40. 40.
    Campbell F, Azadeh B (2008) Cystic neoplasms of the exocrine pancreas. Histopathology 52:539–551PubMedCrossRefGoogle Scholar
  41. 41.
    Wargo JA, Fernandez-del-Castillo C, Warshaw AL (2009) Management of pancreatic serous cystadenomas. Adv Surg 43:23–34PubMedCrossRefGoogle Scholar
  42. 42.
    Mohr VH, Vortmeyer AO, Zhuang Z, et al. (2000) Histopathology and molecular genetics of multiple cysts and microcystic (serous) adenomas of the pancreas in von Hippel–Lindau patients. Am J Pathol 157:1615–1621PubMedCrossRefGoogle Scholar
  43. 43.
    Adsay NV (2008) Cystic neoplasia of the pancreas: pathology and biology. J Gastrointest Surg 12:401–404PubMedCrossRefGoogle Scholar
  44. 44.
    Strobel O, Z’Graggen K, Schmitz-Winnenthal FH, et al. (2003) Risk of malignancy in serous cystic neoplasms of the pancreas. Digestion 68:24–33PubMedCrossRefGoogle Scholar
  45. 45.
    Choi JY, Kim MJ, Lee JY, et al. (2009) Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. AJR Am J Roentgenol 193:136–142PubMedCrossRefGoogle Scholar
  46. 46.
    Gabata T, Terayama N, Yamashiro M, et al. (2005) Solid serous cystadenoma of the pancreas: MR imaging with pathologic correlation. Abdom Imaging 30:605–609PubMedCrossRefGoogle Scholar
  47. 47.
    Sahani DV, Kadavigere R, Saokar A, et al. (2005) Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics 25:1471–1484PubMedCrossRefGoogle Scholar
  48. 48.
    Hayashi K, Fujimitsu R, Ida M, et al. (2012) CT differentiation of solid serous cystadenoma vs endocrine tumor of the pancreas. Eur J Radiol 81(3):e203–e208PubMedCrossRefGoogle Scholar
  49. 49.
    Tseng JF, Warshaw AL, Sahani DV, Lauwers GY, Rattner DW (2005) Fernandez-del Castillo C. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg 242:413–419 (discussion 419-421)PubMedGoogle Scholar
  50. 50.
    Ballarin R, Spaggiari M, Cautero N, et al. (2011) Pancreatic metastases from renal cell carcinoma: the state of the art. World J Gastroenterol 17:4747–4756PubMedCrossRefGoogle Scholar
  51. 51.
    Klein KA, Stephens DH, Welch TJ (1998) CT characteristics of metastatic disease of the pancreas. Radiographics 18:369–378PubMedGoogle Scholar
  52. 52.
    Muranaka T, Teshima K, Honda H, et al. (1989) Computed tomography and histologic appearance of pancreatic metastases from distant sources. Acta Radiol 30:615–619PubMedCrossRefGoogle Scholar
  53. 53.
    Kassabian A, Stein J, Jabbour N, et al. (2000) Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. Urology 56:211–215PubMedCrossRefGoogle Scholar
  54. 54.
    Ng CS, Loyer EM, Iyer RB, et al. (1999) Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJR Am J Roentgenol 172:1555–1559PubMedCrossRefGoogle Scholar
  55. 55.
    Sellner F, Tykalsky N, De Santis M, Pont J, Klimpfinger M (2006) Solitary and multiple isolated metastases of clear cell renal carcinoma to the pancreas: an indication for pancreatic surgery. Ann Surg Oncol 13:75–85PubMedCrossRefGoogle Scholar
  56. 56.
    Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167PubMedCrossRefGoogle Scholar
  57. 57.
    Pitt SC, Moley JF (2010) Medullary, anaplastic, and metastatic cancers of the thyroid. Semin Oncol 37:567–579PubMedCrossRefGoogle Scholar
  58. 58.
    Chi DD, Moley JF (1998) Medullary thyroid carcinoma: genetic advances, treatment recommendations, and the approach to the patient with persistent hypercalcitoninemia. Surg Oncol Clin N Am 7:681–706PubMedGoogle Scholar
  59. 59.
    Modlin IM, Sandor A (1997) An analysis of 8305 cases of carcinoid tumors. Cancer 79:813–829PubMedCrossRefGoogle Scholar
  60. 60.
    You DD, Choi DW, Choi SH, et al. (2011) Surgical resection of metastasis to the pancreas. J Korean Surg Soc 80:278–282PubMedCrossRefGoogle Scholar
  61. 61.
    UK Myeloma Forum. British Committee for Standards in Haematology (2001) Diagnosis and management of multiple myeloma. Br J Haematol 115:522–540CrossRefGoogle Scholar
  62. 62.
    Kazama T, Ng CS, Giralt SA (2005) Multiphasic CT and MRI appearances of extramedullary multiple myeloma involving the stomach, pancreas, and bladder. Clin Imaging 29:263–265PubMedCrossRefGoogle Scholar
  63. 63.
    Gupta P, Rice GD, Abraham K, Ghole V, Ketkar M (2009) Extramedullary plasmacytoma of the pancreas and jejunum. Clin Imaging 33:240–243PubMedCrossRefGoogle Scholar
  64. 64.
    Grotemeyer D, Duran M, Park EJ, et al. (2009) Visceral artery aneurysms–follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 394:1093–1100PubMedCrossRefGoogle Scholar
  65. 65.
    de Perrot M, Berney T, Deleaval J, et al. (1999) Management of true aneurysms of the pancreaticoduodenal arteries. Ann Surg 229:416–420PubMedCrossRefGoogle Scholar
  66. 66.
    Kallamadi R, Demoya MA, Kalva SP (2009) Inferior pancreaticoduodenal artery aneurysms in association with celiac stenosis/occlusion. Semin Intervent Radiol 26:215–223PubMedCrossRefGoogle Scholar
  67. 67.
    Murata S, Tajima H, Fukunaga T, et al. (2006) Management of pancreaticoduodenal artery aneurysms: results of superselective transcatheter embolization. AJR Am J Roentgenol 187:W290–W298PubMedCrossRefGoogle Scholar
  68. 68.
    Yoneyama F, Tsuchie K, Kuno T, et al. (1998) Aneurysmal rupture of the pancreaticoduodenal artery successfully treated by transcatheter arterial embolization. J Hepatobiliary Pancreat Surg 5:104–107PubMedCrossRefGoogle Scholar
  69. 69.
    Fankhauser GT, Stone WM, Naidu SG, et al. (2011) The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 53:966–970PubMedCrossRefGoogle Scholar
  70. 70.
    Koito K, Namieno T, Nagakawa T, et al. (2001) Congenital arteriovenous malformation of the pancreas: its diagnostic features on images. Pancreas 22:267–273PubMedCrossRefGoogle Scholar
  71. 71.
    Halpern M, Turner AF, Citron BP (1968) Angiodysplasias of the abdominal viscera associated with hereditary hemorrhagic telangiectasia. Am J Roentgenol Radium Ther Nucl Med 102:783–789PubMedGoogle Scholar
  72. 72.
    Chang S, Lim HK, Lee WJ, Choi D, Jang KT (2004) Arteriovenous malformation of the pancreas in a patient with gastrointestinal bleeding: helical CT findings. Abdom Imaging 29:259–262PubMedCrossRefGoogle Scholar
  73. 73.
    Tano S, Ueno N, Ueno T, et al. (1996) Pancreatic arteriovenous malformation with duodenal ulcer. Demonstration by color Doppler ultrasonography. Dig Dis Sci 41:1232–1237PubMedCrossRefGoogle Scholar
  74. 74.
    Nishiyama R, Kawanishi Y, Mitsuhashi H, et al. (2000) Management of pancreatic arteriovenous malformation. J Hepatobiliary Pancreat Surg 7:438–442PubMedCrossRefGoogle Scholar
  75. 75.
    Paranjape C, Johnson SR, Khwaja K, et al. (2004) Clinical characteristics, treatment, and outcome of pancreatic Schwannomas. J Gastrointest Surg 8:706–712PubMedCrossRefGoogle Scholar
  76. 76.
    Oshima M, Yachida S, Suzuki Y (2010) Pancreatic schwannoma in a 32-year-old woman mimicking a solid-pseudopapillary neoplasm. Clin Gastroenterol Hepatol 8:e1–e2PubMedCrossRefGoogle Scholar
  77. 77.
    Novellas S, Chevallier P, Saint Paul MC, Gugenheim J, Bruneton JN (2005) MRI features of a pancreatic schwannoma. Clin Imaging 29:434–436PubMedCrossRefGoogle Scholar
  78. 78.
    Halpert B, Gyorkey F (1959) Lesions observed in accessory spleens of 311 patients. Am J Clin Pathol 32:165–168PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Priya R. Bhosale
    • 1
  • Christine O. Menias
    • 2
  • Aparna Balachandran
    • 1
  • Eric P. Tamm
    • 1
  • Chusilp Charnsangavej
    • 1
  • Isaac R. Francis
    • 3
  • Khaled M. Elsayes
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Mallinckrodt Institute of RadiologyWashington University in Saint LouisSt. LouisUSA
  3. 3.Department of Diagnostic RadiologyUniversity of Michigan Health CenterAnn ArborUSA

Personalised recommendations