Presentation is loading. Please wait.

Presentation is loading. Please wait.

RSNA 2004 Everything You Need to Know About Solid and Papillary Epithelial Neoplasms of the Pancreas RSNA 2004 Department of Radiology/Surgery+/Pathology++

Similar presentations


Presentation on theme: "RSNA 2004 Everything You Need to Know About Solid and Papillary Epithelial Neoplasms of the Pancreas RSNA 2004 Department of Radiology/Surgery+/Pathology++"— Presentation transcript:

1 RSNA 2004 Everything You Need to Know About Solid and Papillary Epithelial Neoplasms of the Pancreas RSNA 2004 Department of Radiology/Surgery+/Pathology++ University of Miami School of Medicine/Jackson Memorial Hospital University of Miami School of Medicine/Jackson Memorial Hospital Click Here to Begin Click Here to Begin O Qureshi MD VJ Casillas MD L Rivas MD JU Levi MD + M Jorda MD ++ C Solozarno MD +

2 Start from Beginning History of Solid and Papillary Epithelial Neoplasms of the Pancreas (SPEN) 1959: Described by Frantz as “papillary tumor of pancreas, benign or malignant” 1959: Described by Frantz as “papillary tumor of pancreas, benign or malignant” 1970: Pathology first described by Hamoudi 1970: Pathology first described by Hamoudi 1981: Became a well-known clinical entity after publication of cases by Klöppel 1981: Became a well-known clinical entity after publication of cases by Klöppel 1996: Renamed by the World Health Organization as solid-pseudopapillary tumor (SPT) 1996: Renamed by the World Health Organization as solid-pseudopapillary tumor (SPT) Start from Beginning

3 Also Known As… Solid pseudopapillary tumor (SPT) Solid pseudopapillary tumor (SPT) Frantz’s tumor Frantz’s tumor Papillary cystic neoplasm of the pancreas Papillary cystic neoplasm of the pancreas Solid cystic papillary tumor Solid cystic papillary tumor Solid and cystic acinar cell tumor Solid and cystic acinar cell tumor Papillary tumor of the pancreas Papillary tumor of the pancreas Papillary epithelial neoplasm Papillary epithelial neoplasm

4 Start from BeginningEtiology Pluripotential pancreatic embryonic stem cells Pluripotential pancreatic embryonic stem cells Cells capable of endocrine or exocrine differentiation Cells capable of endocrine or exocrine differentiation Variety of markers from various pancreatic cell types Variety of markers from various pancreatic cell types

5 Start from BeginningEtiology Alternative hypothesis that SPEN originates from genital ridge-related cells incorporated into pancreas during organogenesis Alternative hypothesis that SPEN originates from genital ridge-related cells incorporated into pancreas during organogenesis Prevalence in women suggests hormonal influence Prevalence in women suggests hormonal influence Case report of increased tumor growth during pregnancy Case report of increased tumor growth during pregnancy

6 Start from Beginning Genetics Alterations in APC/ß-catenin pathway Alterations in APC/ß-catenin pathway Also identified in pancreatoblastomas and acinar cell carcinomas Also identified in pancreatoblastomas and acinar cell carcinomas Nuclear and cytoplasmic accumulation of ß- catenin protein in 95% cases (study of 20 patients) Nuclear and cytoplasmic accumulation of ß- catenin protein in 95% cases (study of 20 patients) Activating ß-catenin oncogene mutations in 90% Activating ß-catenin oncogene mutations in 90% Over expression of cyclin D1 protein in 74% Over expression of cyclin D1 protein in 74% Predilection for young females not understood Predilection for young females not understood

7 Start from BeginningEpidemiology Prevalence: 0.13 – 2.7% of all pancreatic tumors Prevalence: 0.13 – 2.7% of all pancreatic tumors 82-93% cases in women 82-93% cases in women 70% tumors occur under age of 30 70% tumors occur under age of 30 Average age at presentation: Average age at presentation: Men present with disease at an age 10 years older than women Men present with disease at an age 10 years older than women

8 Start from BeginningEpidemiology Racial predilection Racial predilection Blacks and East Asians Blacks and East Asians 50% of reported cases in the United States amongst African-Americans 50% of reported cases in the United States amongst African-Americans SPEN in children show less female preponderance than in adults SPEN in children show less female preponderance than in adults

9 Start from Beginning Gross Pathology Specimens range from 2 to 25 cm Specimens range from 2 to 25 cm May occur throughout pancreas, more common in head and tail; Exophytic growth pattern May occur throughout pancreas, more common in head and tail; Exophytic growth pattern Well-circumscribed with fibrous capsule Well-circumscribed with fibrous capsule Solid, cystic, and papillary regions Solid, cystic, and papillary regions Variable degrees of internal hemorrhage Variable degrees of internal hemorrhage Necrotic and thrombotic contents Necrotic and thrombotic contents Fluid-debris levels in cystic cavities Fluid-debris levels in cystic cavities

10 Start from Beginning Cystic Cystic Solid Solid Mixture of components Mixture of components Hemorrhage and fluid levels Hemorrhage and fluid levels Peripheral calcifications Peripheral calcifications

11 Start from BeginningCytology Aspirates are highly cellular Aspirates are highly cellular FNA: 72% diagnostic or suggestive of SPEN FNA: 72% diagnostic or suggestive of SPEN Solid areas: Necrosis, foamy macrophages, cholesterol granulomas, and occasionally calcifications Solid areas: Necrosis, foamy macrophages, cholesterol granulomas, and occasionally calcifications Papillary configurations: Fibrovascular stalk surrounded by several layers of epithelial cells Papillary configurations: Fibrovascular stalk surrounded by several layers of epithelial cells Frequently arranged around tiny vessels as “pseudorosettes” Frequently arranged around tiny vessels as “pseudorosettes” Poorly supported blood vessels that result in numerous and extensive hemorrhage Poorly supported blood vessels that result in numerous and extensive hemorrhage

12 Start from Beginning Tumor cells arranged around a hyalinized fibrovascular stalk

13 Start from BeginningCytology Absence of pleomorphism, hyperchromasia, or mitotic activity Absence of pleomorphism, hyperchromasia, or mitotic activity Bland, oval to round nuclei that may contain small nucleoli and grooves or folds Bland, oval to round nuclei that may contain small nucleoli and grooves or folds Eosinophilic granular cytoplasm Eosinophilic granular cytoplasm Hyaline cytoplasmic globules, multinucleated giant cells Hyaline cytoplasmic globules, multinucleated giant cells Infiltrative growth pattern into adjacent pancreas despite gross circumscription Infiltrative growth pattern into adjacent pancreas despite gross circumscription

14 Start from BeginningImmunohistochemistry Commonly seen immunoreactivity Commonly seen immunoreactivity CD 10 and CD 56 CD 10 and CD 56 Found in all cases in a study of 19 patients Found in all cases in a study of 19 patients α-1 antitrypsin α-1 antitrypsin Neuron-specific enolase Neuron-specific enolase Vimentin Vimentin Progesterone receptors Progesterone receptors Stains negative for: Stains negative for: chromogranin A chromogranin A

15 Start from BeginningImmunohistochemistry Neuron-specific enolase positiveChromogranin A negative

16 Start from BeginningImmunohistochemistry Occasionally stains positive for: Occasionally stains positive for: Keratin Keratin α-1 antichymotrypsin α-1 antichymotrypsin Synapthophysin Synapthophysin S-100 protein S-100 protein Neurosecretory granules occasionally seen Neurosecretory granules occasionally seen

17 Start from Beginning Clinical Presentation Vague symptoms Vague symptoms Abdominal fullness or discomfort Abdominal fullness or discomfort Epigastric or LUQ abdominal pain Epigastric or LUQ abdominal pain Early satiety Early satiety Asymptomatic: 9% Asymptomatic: 9% Duration of symptoms: acute to 5 years Duration of symptoms: acute to 5 years Nontender, palpable mass in LUQ or RUQ Nontender, palpable mass in LUQ or RUQ

18 Start from Beginning Clinical Presentation Symptoms also seen: Jaundice, polyarthralgia, dyspepsia, weight loss, nausea, anorexia Symptoms also seen: Jaundice, polyarthralgia, dyspepsia, weight loss, nausea, anorexia Laboratory values are non-diagnostic Laboratory values are non-diagnostic Rare cases exhibit mildly elevated CA 19-9 values, eosinophilia Rare cases exhibit mildly elevated CA 19-9 values, eosinophilia Nonspecific symptomology often leads to a delay in diagnosis Nonspecific symptomology often leads to a delay in diagnosis Diagnosis is often incidental Diagnosis is often incidental

19 Start from Beginning University of Miami Case Series Cases obtained from the institutional hospital of the University of Miami, Jackson Memorial Hospital Cases obtained from the institutional hospital of the University of Miami, Jackson Memorial Hospital 15 cases of surgically resected and pathology proven SPEN collected for retrospective review 15 cases of surgically resected and pathology proven SPEN collected for retrospective review

20 Start from Beginning University of Miami Case Series Gender # of Cases Avg. Age Range Female Male

21 Start from Beginning University of Miami Case Series 87% of cases in females, consistent with expected prevalence 87% of cases in females, consistent with expected prevalence Average age at presentation of 21.5 within expected normal for SPEN Average age at presentation of 21.5 within expected normal for SPEN Male age of presentation > female, but also much higher than normally observed Male age of presentation > female, but also much higher than normally observed

22 Start from Beginning Ultrasound Findings Well-encapsulated masses with variable echotexture Well-encapsulated masses with variable echotexture Combined cystic and solid portions Combined cystic and solid portions May demonstrate septations and internal echoes May demonstrate septations and internal echoes Solid masses with good through-transmission correlate to friable neoplastic tissue with massive hemorrhagic necrosis Solid masses with good through-transmission correlate to friable neoplastic tissue with massive hemorrhagic necrosis Masses of low echogenicity correspond to neoplastic tissue with focal cystic degeneration Masses of low echogenicity correspond to neoplastic tissue with focal cystic degeneration Echogenic tumor capsules Echogenic tumor capsules

23 Start from Beginning US : Round complex mass predominantly solid with small cystic components in head of the pancreas 20 yr old white Latin female with RUQ pain, nausea, fatty food intolerance and elevated liver function tests

24 Start from Beginning Transverse scan US: Ovoid cystic mass in the neck of the pancreas 20 yr old female with RUQ abdominal pain

25 Start from Beginning US: Complex mass in the pancreatic head mostly cystic with small solid components 28 yr old female with abdominal pain

26 Start from Beginning US : Well-circumscribed hypoechoic mass (m) in the body of the pancreas with minimal posterior enhancement (arrows) Sagittal midline m 17 yr old female with epigastric pain and early satiety

27 Start from Beginning US: Large hyperechoic solid mass, body and pancreatic tail 13 yr old Black female with abdominal fullness

28 Start from Beginning CT Findings Well-defined, round or lobulated masses Well-defined, round or lobulated masses Heterogeneous with variable ratio of cystic and solid components Heterogeneous with variable ratio of cystic and solid components Regions of hyperdensity correspond to hemorrhage Regions of hyperdensity correspond to hemorrhage Improved definition of mass with IV contrast administration, with slight peripheral enhancement Improved definition of mass with IV contrast administration, with slight peripheral enhancement Peripheral calcifications in ~ 1/3 rd patients Peripheral calcifications in ~ 1/3 rd patients Mass effect on local structures Mass effect on local structures

29 Start from Beginning CT: Pancreatic mass mostly cystic with septations and small solid components 21 yr old Hispanic female with vague abdominal symptoms

30 Start from Beginning CT demonstrates large ovoid complex mass with cystic and solid components involving the body and tail of the pancreas. Biopsy showed that this was SPEN, and not metastasis. 55 yr old Hispanic male with known transitional cell carcinoma of the bladder

31 Start from Beginning CT: Well circumscribed solid mass in the pancreatic tail 26 yr old African-American female with abdominal discomfort

32 Start from Beginning CT: Large complex mass involving the body and tail of the pancreas

33 Start from Beginning CT : Pancreatic mass of low attenuation with thick walls 17 yr old female with epigastric pain and early satiety

34 Start from Beginning CT: Complex pancreatic masses with fluid levels 9 yr old Latin female22 year old Latin female

35 Start from Beginning CT: Large cystic pancreatic mass with mural nodule 19 yr old Black female with progressive LUQ abdominal fullness for three years

36 Start from Beginning CT: Pancreatic mass with mostly cystic, thin walls 28 yr old female with left upper quadrant abdominal pain

37 Start from Beginning CT: Pancreatic mass mostly cystic with peripheral calcifications 37 yr old female with early satiety and abdominal discomfort

38 Start from Beginning MRI Findings Improved visualization of capsule and internal hemorrhage, hence more specific Improved visualization of capsule and internal hemorrhage, hence more specific Well-defined encapsulated lesion Well-defined encapsulated lesion T1: Heterogeneous hypointense or hyperintense signal relative to adjacent pancreatic parenchyma T1: Heterogeneous hypointense or hyperintense signal relative to adjacent pancreatic parenchyma T2: Heterogeneously hyperintense signal T2: Heterogeneously hyperintense signal

39 Start from Beginning MRI Findings Hematocrit effect: Fluid-fluid or fluid- debris levels Hematocrit effect: Fluid-fluid or fluid- debris levels T1 and T2: Peripheral hypointense rim T1 and T2: Peripheral hypointense rim T1 Post-Gadolinium T1 Post-Gadolinium Arterial phase: Heterogeneous peripheral enhancement Arterial phase: Heterogeneous peripheral enhancement Portal and delayed phase: Progressive heterogeneous fill-in (incomplete) Portal and delayed phase: Progressive heterogeneous fill-in (incomplete)

40 Start from Beginning MRI: Low signal intensity mass in the neck of the pancreas on T1WI and high signal intensity on T2WI with fat saturation 20 yr old female with RUQ abdominal pain T1T2 Fat Sat

41 Start from Beginning Classifying SPEN by MRI Influences surgical strategy Influences surgical strategy Type 1: High signal on T1 and T2 – subacute Type 1: High signal on T1 and T2 – subacute Type 2: Low signal on T1 and high signal on T2 – chronic phase after bleeding Type 2: Low signal on T1 and high signal on T2 – chronic phase after bleeding Type 3: Low signal on T1 and homogeneous intermediate signal on T2 -- no bleeding Type 3: Low signal on T1 and homogeneous intermediate signal on T2 -- no bleeding Type 1 and 2 lesions had peripheral rims corresponding to fibrous capsule Type 1 and 2 lesions had peripheral rims corresponding to fibrous capsule Type 3 had only partial capsules indicative of invasive disease, requiring extensive operations Type 3 had only partial capsules indicative of invasive disease, requiring extensive operations

42 Start from Beginning Other Imaging Endoscopic ultrasonography Endoscopic ultrasonography Useful in diagnosis tumors that measure less than 2 cm; Limited utility as most SPEN > 4cm Useful in diagnosis tumors that measure less than 2 cm; Limited utility as most SPEN > 4cm Provides guidance for FNA Provides guidance for FNA Arteriography: Arteriography: Avascular or hypovascular mass Avascular or hypovascular mass Useful in differentiating from islet cell tumors which are typically hypervascular Useful in differentiating from islet cell tumors which are typically hypervascular Calcifications Calcifications Case report of detection by bone scintigraphy Case report of detection by bone scintigraphy Rarely seen on abdominal plain film x-rays Rarely seen on abdominal plain film x-rays

43 Start from Beginning Arteriography : Large hypovascular mass body and tail of the pancreas. Note the displacement of the SMA to the right 13 yr old Haitian female with abdominal fullness

44 Start from Beginning Differential Diagnosis Cystic islet cell tumor Cystic islet cell tumor Serous microcystic adenoma Serous microcystic adenoma Mucinous cystic neoplasm Mucinous cystic neoplasm Intraductal papillary mucinous tumor Intraductal papillary mucinous tumor Acinar cell carcinoma Acinar cell carcinoma Papillary cystadenocarcinoma Papillary cystadenocarcinoma Pancreatoblastoma Pancreatoblastoma Vascular tumors: Hemangioma, lymphangioma, angiosarcoma Vascular tumors: Hemangioma, lymphangioma, angiosarcoma Calcified hemorrhagic pseudocyst Calcified hemorrhagic pseudocyst Inflammatory pseudocyst Inflammatory pseudocyst Dysgenetic cyst, as seen in von Hippel-Lindau and polycystic kidney disease Dysgenetic cyst, as seen in von Hippel-Lindau and polycystic kidney disease Retention cyst, as seen in cystic fibrosis Retention cyst, as seen in cystic fibrosis

45 Start from Beginning Differential Diagnosis Islet cell tumors Islet cell tumors SPEN commonly misdiagnosed as non-functioning islet cell tumors SPEN commonly misdiagnosed as non-functioning islet cell tumors Islet cell tumors are hypervascular with different CT/MRI enhancement patterns Islet cell tumors are hypervascular with different CT/MRI enhancement patterns Cystic components have moderately elevated signal intensity on T1 and increased signal on T2 Cystic components have moderately elevated signal intensity on T1 and increased signal on T2 Pancreatoblastoma Pancreatoblastoma Childhood malignant neoplasm with poor prognosis Childhood malignant neoplasm with poor prognosis Male predominance Male predominance No intratumoral hemorrhage No intratumoral hemorrhage

46 Start from Beginning Differential Diagnosis Acinar cell carcinoma Acinar cell carcinoma Always malignant Always malignant Affects both genders in 6 th or 7 th decades Affects both genders in 6 th or 7 th decades Pancreatic pseudocyst Pancreatic pseudocyst Thin walls Thin walls Totally cystic lesion without any solid component Totally cystic lesion without any solid component History of pancreatitis History of pancreatitis Intraductal papillary mucinous tumor Intraductal papillary mucinous tumor Dilatation of the main pancreatic duct Dilatation of the main pancreatic duct Soft villous tumor associate with Wirsung’s duct Soft villous tumor associate with Wirsung’s duct

47 Start from Beginning Differential Diagnosis Microcystic adenoma Microcystic adenoma Female predominance presenting in 6 th decade Female predominance presenting in 6 th decade CT reveals low-attenuation with marked enhancement with “honeycomb pattern” CT reveals low-attenuation with marked enhancement with “honeycomb pattern” Echogenic central stellate scar Echogenic central stellate scar No peripheral or capsular enhancement on MRI No peripheral or capsular enhancement on MRI Mucinous cystic tumors Mucinous cystic tumors Female predominance presenting in 5 th - 6 th decades Female predominance presenting in 5 th - 6 th decades Large mucin-secreting cysts Large mucin-secreting cysts Multilocularity with thin septations Multilocularity with thin septations

48 Start from BeginningTreatment Definitive treatment is surgical Definitive treatment is surgical Partial pancreatectomy (48%) Partial pancreatectomy (48%) Whipple procedure (29%) Whipple procedure (29%) Local excision (17%) Local excision (17%) Pancreatectomy (6%) Pancreatectomy (6%) No known role for chemotherapy or radiation therapy No known role for chemotherapy or radiation therapy Past cases have resulted in recurrence Past cases have resulted in recurrence Requires lengthy follow-up because of inability to determine aggressive behavior Requires lengthy follow-up because of inability to determine aggressive behavior

49 Start from BeginningPrognosis Surgical resection is often curable Surgical resection is often curable Long-term survival is the rule despite local invasiveness Long-term survival is the rule despite local invasiveness Not related to pathology Not related to pathology Microscopic positive margins not significant predictors of survival Microscopic positive margins not significant predictors of survival

50 Start from BeginningComplications Metastatic disease (6-15%) Metastatic disease (6-15%) Predilection for males and older patients Predilection for males and older patients Predominantly to the liver, less commonly to lymph nodes Predominantly to the liver, less commonly to lymph nodes Also described in spleen, colon, mesentery, skin, lung, generalized carcinomatosis Also described in spleen, colon, mesentery, skin, lung, generalized carcinomatosis May be microscopic and undetectable by imaging May be microscopic and undetectable by imaging Long-term survival in 10-15% patients Long-term survival in 10-15% patients

51 Start from BeginningComplications Pseudocyst formation Pseudocyst formation Death (4%) Death (4%) Hemorrhagic coagulopathy Hemorrhagic coagulopathy Cholangitis Cholangitis Septic shock Septic shock

52 Start from Beginning Solid Pseudopapillary Carcinoma SPEN/SPT with clear malignant criteria SPEN/SPT with clear malignant criteria Vascular and nerve sheath invasion Vascular and nerve sheath invasion Metastasis to lymph node or liver Metastasis to lymph node or liver Morphologically identical to SPEN Morphologically identical to SPEN Average age at presentation: 30 Average age at presentation: 30 Slightly older than that of SPEN Slightly older than that of SPEN Uncertain whether SPEN becomes malignant with tumor growth Uncertain whether SPEN becomes malignant with tumor growth

53 Start from Beginning Interesting Case History: 24 year old black female presents to the ER with acute onset of abdominal pain. Pain is epigastric, sharp, and constant. Denies fever, nausea, vomiting, constipation, or diarrhea Labs: Elevated LFT’s

54 Start from Beginning CT: 2 x 2 cm mass located in the porta hepatis. CT-FNA was nondiagnostic

55 Start from Beginning MRI: T1W images demonstrate hypointense mass in porta hepatis MRI: T1W images demonstrate hypointense mass in porta hepatis T1

56 Start from Beginning Note the mass has relatively high MRI: Note the mass has relatively high signal on T2W image T2

57 Start from Beginning MRCP: Obstruction of the biliary system at the biliary bifurcation and proximal CHD (mass effect) Surgical pathology reveals solid mass engulfing bifurcation of CBD with extension to cystic and hepatic ducts Cut section: Solid and cystic, filled with necrotic debris

58 Start from Beginning Interesting Case Histology: Fibrous capsule with lobules containing papillary pattern, consisting of epithelial cells around hyalinized fibrovascular stalks Histology: Fibrous capsule with lobules containing papillary pattern, consisting of epithelial cells around hyalinized fibrovascular stalks RBC’s in spaces between papillary structures RBC’s in spaces between papillary structures Extensive perineural invasion and focal lymphovascular space involvement Extensive perineural invasion and focal lymphovascular space involvement

59 Start from Beginning Interesting Case Diagnosis: Solid and papillary epithelial neoplasm of the extrahepatic bile ducts Diagnosis: Solid and papillary epithelial neoplasm of the extrahepatic bile ducts Majority of extrapancreatic SPEN (a very rare entity) affiliated with heterotopic pancreatic tissue Majority of extrapancreatic SPEN (a very rare entity) affiliated with heterotopic pancreatic tissue

60 Start from Beginning Review Quiz Who is most likely to be affected by SPEN? A. 70 year old black male B. 6 year old white female C. 21 year old Asian female D. 45 year old white male

61 Start from Beginning Review Quiz The answer is C, 21 year old Asian female. SPEN has a racial predilection for young females, predominantly in the black and Asian population.

62 Start from Beginning Review Quiz Which is uncharacteristic of SPEN? A. Internal hemorrhage B. Cystic mucinous secretions C. Fluid-debris levels D. Fibrous capsule

63 Start from Beginning Review Quiz The answer is B. Cysts are seen in almost every case of SPEN. However, mucin secretion is NOT characteristic of this neoplasm. Such secretions are seen in mucinous cystic tumors of the pancreas, which is included in the differential diagnosis of SPEN.

64 Start from Beginning Review Quiz MRI imaging offers which benefit? A. Improved detection of intratumoral blood B. Better visualization of the capsule C. Specific enhancement pattern D. All of the above

65 Start from Beginning Review Quiz The answer is D, all of the above. MRI offers all of the mentioned benefits, making it a more specific test than CT or ultrasound in the diagnosis of SPEN.

66 Start from Beginning Review Quiz Which of the following statements about SPEN is false? A. Clinical presentation is classic B. Stains negative for chromogranin A C. Fibrovascular stalks are seen in cytology D. Pseudocyst is in the differential diagnosis

67 Start from Beginning Review Quiz The answer is A. SPEN presents with vague abdominal symptoms, including fullness, pain, and early satiety. However, presentation is anything but classic.

68 Start from Beginning Review Quiz What percent of SPEN metastasize? A. Almost never B. 5-15% C. 50% D. Greater than 80%

69 Start from Beginning Review Quiz The answer is B, 5-15%. SPEN has low malignant potential. Hence it is mandatory to establish early diagnosis, as surgical removal of tumor offers an excellent prognosis. Even in cases of local invasiveness or metastasis, the outcome can be promising if properly treated.

70 Start from BeginningReferences Abraham SC, Klimstra DS, Wilentz RE, et al. Solid-pseudopapillary tumors of the pancreas are genetically distinct from pancreatic ductal adenocarcinomas and almost always harbor ß-catenin mutations. American Journal of Pathology 2002; 160: Balthazar EJ, Subramanyam BR, Lefleur RS, Barone CM. Solid and papillary epithelial neoplasm of the pancreas. Radiology 1984; 150: Bardales RH, Centeno B, Mallery S, Lai R. Endoscopic ultrasound-guided fine-needle aspiration of cytology diagnosis of solid- pseudopapillary tumor of the pancreas: a rare neoplasm of elusive origin but characteristic cytmorphologic features. Am J Clin Pahtol 2004; 121: Buetow PC, Buck JL, Pantongrag-Brown, et al. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation in 56 cases. Radiology 1996; 199: Cantisani V, Mortele KJ, Levy A, et al. MR imaging features of the solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR 2003; 181: Choi BT, Kim KW, Han MC, et al. Solid and papillary epithelial neoplasms of the pancreas: ct findings. Radiology 1988; 166: Coleman KM, Doherty MC, Bigley SA. Solid-pseudopapillary tumor of the pancreas. Radiographics 2003; 23: Crawford BE. Solid and papillary epithelial neoplasm of the pancreas, diagnosis by cytology. Southern Medical Journal, 1998; 91: Friedman AC, Lichtenstein JE, Fishman EK. Solid and papillary epithelial neoplasm of the pancreas. Radiology 1985; 154: Habib, F, Sleeman D, DiMugno L, et al. Solid and papillary epithelial neoplasm of the extrahepatic bile ducts. Univ Miami School of Medicine poster.

71 Start from BeginningReferences Hurley ME, Corbally M, McDermott M. Solid pseudopapillary tumour of the pancreas. 1 Apr Jung SE, Kim DY, Park KW, et al. Solid and papillary epithelial neoplasm of the pancreas in children. World J Surg 1999; 3: Koizumi J. Solid and papillary epithelial neoplasms of the pancreas: classification based on MR imaging Lee DH, Yi BH, Joo WL, Ko YT. Sonographic findings of solid and papillary neoplasms of the pancreas. J Ultrasound Med 2001; 20: Martin RCG, Klimstra DS, Brennan MF, Conlon KC. Solid-pseudopapillary tumor of the pancreas: a surgical enigma? Annals of Surgical Oncology 2002; 9: Nishiguchi S, Kubo S, Shiomi S. Bone scintigraphy reveals a solid and papillary epithelial neoplasm of the pancreas. AJR 2002; 178; Notohara K, Hamakazi S, Tsukayama C, et al. Solid-pseduopapillary tumor of the pancreas immunohistochemical localization of neuroendocrine markers and CD10. Am J Surg Pathol 2000; 24: Othomo N, Furui S, Onoue M, et al. Solid and papillary epithelial neoplasm of the pancreas: MR imaging and pahtologic correlation. Radiology 1992; 184: Schenker MP. Solid pseudopapillary tumor of pancreas. 28 Apr

72 Start from BeginningReferences Shimizu M, Matsumoto T, Hirokawa M, et al. Solid-pseudopapillary carcinoma of the pancreas. Pathology International 1999; 49: Thompson LDR. January Vivek D. Cystic and papillary epithelial neoplasm of the pancreas. Zeytunlu M, Firat O, Nart D, et al. Solid and cystic papillary neoplasms of the pancreas: report of four cases. Turkish J of Gastroenterolgoy 2004; 15:


Download ppt "RSNA 2004 Everything You Need to Know About Solid and Papillary Epithelial Neoplasms of the Pancreas RSNA 2004 Department of Radiology/Surgery+/Pathology++"

Similar presentations


Ads by Google