Solid Pseudopapillary Neoplasm With Extensive Intratumoral Hemorrhage

Figures

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  Figure 1. Multiphasic abdominal CT of the pancreatic head mass A: unenhanced phase; B: arterial phase; C: venous phase; D: delayed phase. The lesion is well circumscribed and cystic and solid. The unenhanced image shows internal areas of relatively increased attenuation, while the non-cystic component shows mild heterogeneous enhancement on the post-contrast phases. The descending duodenum is compressed and displaced. The yellow arrow indicates the tumor, while the purple arrow indicates a crescent-shaped, slightly hyperattenuating area, possibly representing intratumoral hemorrhage CT: computed tomography

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  Figure 2. Coronal thick-slab respiratory-triggered 3D MRCP image The image shows an enlarged gallbladder, mild dilatation of the common bile duct (measured at approximately 1.07 cm), a visible distal common bile duct without definite stenosis, and a visible main pancreatic duct MRCP: magnetic resonance cholangiopancreatography (protocol name: VWIP 3D MRCP RT)

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  Figure 3. Multiparametric and contrast-enhanced MRI of the pancreatic head mass A: T1-weighted image showing peripheral and internal intrinsic T1 hyperintensity compatible with blood products; B: T2-weighted image showing marked internal heterogeneity; C: DWI; D: ADC map with the measurement ROI; E: arterial phase; F: venous phase; G: coronal venous-phase reconstruction; H: delayed phase. A non-cystic portion shows mild to moderate post-contrast enhancement, and the capsule enhances. Restricted diffusion and the ADC measurement are not specific for viable tumor, because clotted blood products may also restrict diffusion. The white arrow indicates the tumor, while the green arrow indicates a crescent-shaped area of T1 hyperintensity, suggestive of intratumoral hemorrhage, as blood products commonly exhibit high signal intensity on unenhanced T1-weighted images MRI: magnetic resonance imaging; DWI: diffusion-weighted imaging; ADC: apparent diffusion coefficient; ROI: region of interest

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  Figure 4. Gross appearance of the surgically resected specimen The pancreatic head mass had a relatively intact capsule, and the cut surface was cystic and solid, and contained a large amount of bloody fluid

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  Figure 5. Histological appearance of the tumor The tumor cells were spindle-shaped or round, with clear or vacuolated cytoplasm, and hemorrhage was present in the background. Hematoxylin and eosin staining; original magnification, ×200

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  Figure 6. Follow-up CT image of the whole abdomen one week after discharge A follow-up full-abdominal CT scan one week after discharge showed changes after pancreaticoduodenectomy. The drainage tube and surgical stapler (white short arrow) could be seen without other clear abnormalities CT: computed tomography

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  Figure 7. Whole-gastrointestinal-tract digital contrast study after surgery A: After oral administration of contrast medium, the esophagus, stomach, and duodenum were evaluated. Contrast material passed from the gastric antrum into the duodenal bulb, as indicated by the white circle and arrow. B: Six hours later, contrast medium entered the colon with clear visualization. Contrast material within the colon is indicated by the white circle and arrow, demonstrating the characteristic haustral pattern