Carcinoid tumours are most commonly found in the appendix and small bowel. Barium studies usually disclose a small solitary mucosal or submucosal mass in the distal ileum at times associated with smooth muscle hypertrophy and thickening of the mucosal folds. Intussusception and bowel obstruction may be the presenting finding. Mesenteric involvement may evoke a desmoplastic reaction with rigidity, fixation, angulation and tethering of small bowel loops. Angiography may demonstrate a hypervascular primary neoplasm but more frequentyly reveals vascular encasement and distortion from the mesenteric desmoplastic reaction.

Pancreatic islet cell tumour is best defined radiologically by angiography and computed tomography as a well circumscribed hypervascular mass which enhances with contrast material. Portal venous sampling is of considerable assistance in localizing insulinoma.

Metastases from neuroendocrine tumours to lymph nodes and to the liver are usually hypervascular. In the evaluation of the liver by CT scanning prior to contrast as well as dynamic scanning during the bolus intravenous injection of contrast material are necessary. At times the precontrast scan is mesenteric artery followed by selective hepatic arteriography is the most accurate combination for the detection of hepatic metastases.

Interventional radiological management by sequential hepatic arterial embolization is the treatment of choice for multiple hepatic metastases from neuroendocrine tumours. Thus far, the maximum number of embolic episodes in a single patient has been 13. The carcinoid syndrome has been controlled in 87%while 79%of islet cell tumour hepatic metastases have responded.

Contraindications to HAE includes a combination of <span style='font-style: italic'>allspan> of the following: (i) replacement of more than 50%of the liver by tumour, (ii) serum lactic dehydrogenase above 425 mU/ml, (iii) serum glutamic oxaloacetic transaminase above 100mU/ml, and (iv) bilirubin above 2 mg/dl. In the face of occlusion of the portal vein by intravascular neoplasm, HAE is contraindicated only if portal flow through collateral vein is away from the liver.

sciencedirect.com/science?_ob=MImg&_imagekey=B7G7C-4FN2J25-T-1&_cdi=19951&_user=10&_orig=article&_coverDate=05%2F31%2F1989&_sk=999969998&view=c&wchp=dGLbVtz-zSkWb&md5=093800fc16f9e632a7f276ceb001182f&ie=/sdarticle.pdf">style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (11098 K)

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science?_ob=ArticleURL&_udi=B6T5C-4839JPY-7&_user=10&_origUdi=B6WCP-4RR214J-1&_fmt=high&_coverDate=04%2F30%2F2003&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8662015fbc704fc1eb6eebb5b67e0016" onMouseOver="InfoBubble.show('infobubble_2','mlktLink_2')" onMouseOut="InfoBubble.timeout()">Solid, cystic and vanishing tumors of the pancreas
Clinical Imaging

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src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> sciencedirect.com/science?_ob=ArticleURL&_udi=B6T5C-4839JPY-7&_user=10&_coverDate=04%2F30%2F2003&_rdoc=1&_fmt=high&_orig=article&_cdi=4999&_sort=v&_docanchor=&view=c&_ct=1031&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1bfadf17fe0e1919f0cff28afa7c06d3">Solid, cystic and vanishing tumors of the pancreas
Clinical Imaging, Volume 27, Issue 2, March-April 2003, Pages 106-108
Masahiko Hachiya, Yuriko Hachiya, Kazumasa Mitsui, Ichiro Tsukimoto, Kiyoshi Watanabe, Tomoo Fujisawa

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style="line-height:150%">Two girls with pancreatic tumors are reported. They were presented with abdominal pain, no history of abdominal injury and no tumor marker abnormalities. Imaging studies demonstrated that the tumors in two patients had both solid and cystic components. The tumors gradually regressed and finally disappeared without any treatment. There has been no evidence of recurrence in 5- and 4-year observation periods, respectively. Pancreatic tumor with solid and cystic components may rarely be self-limited.

sciencedirect.com/science?_ob=MImg&_imagekey=B6T5C-4839JPY-7-C&_cdi=4999&_user=10&_orig=article&_coverDate=04%2F30%2F2003&_sk=999729997&view=c&wchp=dGLbVtz-zSkWb&md5=44b4ad2458885cd5bce3d3ce8c0c3d53&ie=/sdarticle.pdf">style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (164 K)

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science?_ob=ArticleURL&_udi=B758V-4SK5VM5-5&_user=10&_origUdi=B6WCP-4RR214J-1&_fmt=high&_coverDate=08%2F31%2F2008&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0952d4916a96b317e652052292f9e885" onMouseOver="InfoBubble.show('infobubble_3','mlktLink_3')" onMouseOut="InfoBubble.timeout()">Uncommon Tumors and Pseudotumoral Lesions of the Pancre...
Current Problems in Diagnostic Radiology

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src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> sciencedirect.com/science?_ob=ArticleURL&_udi=B758V-4SK5VM5-5&_user=10&_coverDate=08%2F31%2F2008&_rdoc=1&_fmt=high&_orig=article&_cdi=12936&_sort=v&_docanchor=&view=c&_ct=1031&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4cd68cfb06778cbe7d24f5d18fc1fbe7">Uncommon Tumors and Pseudotumoral Lesions of the Pancreas
Current Problems in Diagnostic Radiology, Volume 37, Issue 4, July-August 2008, Pages 145-164
Carmen de Juan, Marcelo Sanchez, Rosa Miquel, Mario Pages, Juan Ramon Ayuso, Carmen Ayuso

Abstract

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style="line-height:150%">Ductal adenocarcinoma is the most common tumor of the pancreas, accounting for about 80%of all pancreatic tumors. The other 20%of pancreatic tumors is represented by a heterogeneous group of pancreatic neoplasms that includes cystic pancreatic neoplasms, islet cell tumors, and the so-called rare pancreatic tumors. In addition, the pancreatic gland may present a variety of inflammatory and pseudotumoral lesions that may mimic a primary pancreatic neoplasm. These uncommon tumors and pseudotumoral lesions present a wide spectrum of imaging findings and they are often poorly understood by the radiologist, becoming a diagnostic challenge. Some of these lesions may show an appearance similar to ductal adenocarcinoma being radiologically indistinguishable. However, some of these lesions sometimes may present specific features on imaging studies that may help to characterize the mass and to suggest a correct diagnosis. Many of these uncommon tumors and pseudotumoral lesions have a different approach, therapy, and prognosis than ductal adenocarcinoma. Therefore, it is important for the radiologist to be familiar with these entities to include them in the differential diagnosis to initiate an appropriate lesion-specific workup and treatment. In the present article, we review the radiological features of uncommon pancreatic tumors, atypical manifestations of ductal adenocarcinoma, and pseudotumoral masses, focusing on those features that can be helpful for the differential diagnosis.

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Secretin-assisted CT of the pancreas: improved pancreatic enhancement and tumour conspicuity

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