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Tumor thrombosis: a peculiar finding associated with pancreatic neuroendocrine neoplasms. A pictorial essay

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Abstract

While abutment, encasement or vessel occlusion are identified in most patients with a pancreatic tumor, tumor thrombosis is an uncommon finding. In particular, there are no description in the literature of tumor thrombosis associated with ductal adenocarcinoma, the most common pancreatic tumor. On the other hand, surgical series reveal that tumor thrombosis is associated with about 5% of pancreatic neuroendocrine neoplasms (PanNENs), and literature data suggest that this finding is frequently underreported on pre-operative imaging examinations. Tumor thrombosis may be clinically relevant, causing splenoportomesenteric hypertension, possibly responsible for life-threatening upper gastrointestinal bleeding. Bland thrombosis caused by direct infiltration of peri-pancreatic vessels frequently determines surgical unresectability, even in neuroendocrine tumors; on the opposite, tumor thrombosis associated with PanNENs do not exclude surgery per se, even though both morbidity and mortality can be increased by such condition. Considering the favorable prognosis of PanNENs and the frequent need to treat tumor thrombosis in order to prevent complications or to relieve symptoms, it is of paramount importance for radiologists the knowledge of the variety of findings associated with tumor thrombosis in PanNENs.

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Authors and Affiliations

  1. Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy

    Riccardo De Robertis, Nicolò Cardobi & Paolo Tinazzi Martini

  2. Department of General and Pancreatic Surgery, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Salvatore Paiella, Luca Landoni & Claudio Bassi

  3. Department of Oncology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy

    Silvia Ortolani

  4. Department of Gastroenterology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Giulia De Marchi

  5. Department of Pathology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy

    Stefano Gobbo

  6. Department of Pancreatic Surgery, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy

    Alessandro Giardino & Giovanni Butturini

  7. Department of Medical Oncology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Giampaolo Tortora

  8. Department of Radiology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Mirko D’Onofrio

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  1. Riccardo De Robertis
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Correspondence to Riccardo De Robertis.

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For this type of study formal consent is not required. Each patient signed adequate informed consent before imaging examination and surgery.

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De Robertis, R., Paiella, S., Cardobi, N. et al. Tumor thrombosis: a peculiar finding associated with pancreatic neuroendocrine neoplasms. A pictorial essay. Abdom Radiol 43, 613–619 (2018). https://doi.org/10.1007/s00261-017-1243-z

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