Pancreas

Question 1

How can pancreatic neoplasms be categorised?

Answer 1

EXOCRINE:

Account for 99% of all primary pancreatic neoplasms and include :

1. Pancreatic ductal adenocarcinoma ~ 90 - 95%
2. Cystic neoplasm such as:

• *mucinous cystic neoplasm; *
• intraductal papillary mucinous neoplasms (IPMN)
• serous cystadenoma

ENDOCRINE aka Islet Cell Tumours

Functional: ~ 85 %

1. insulinoma : most common. 10% are malignant
2. gastrinoma : second most common. 60% malignant
3. glucagonoma : 80% malignant
4. VIPoma : 75% malignant
5. somatostatinoma : 75% malignant

Non-Functional: ~ 15% :

• 85 - 100% malignant
• usually larger 6 - 20cm

Other:

• Metastases (RCC; Bronchogenic Ca)
• Lymphoma
• Sarcomas

Question 2

What is the usual MRI appearance of an Islet Cell Tumour (aka Endocrine tumour) of the Pancreas?

Answer 2

Islet Cell MRI Fx:

• T1W: Hypointense
• T1 + C: May demonstrate enhancement on arterial phase
• T2W: Hyperintense

This case is an insulinoma on T1 and T2

Question 3

What is the DDx for fatty infiltration of the pancreas (pancreatic lipomatosis)?

Answer 3

Diffuse Fatty Infiltration

1. Aging - with associated atrophy
2. Obesity
3. Cystic fibrosis
4. Steroid usage
5. Diabetes Mellitus

Focal Fatty Lesion:

1. Lipoma

The case here is due to CF and is a T1W and CT