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Solid Pseudopapillary Tumor of the Pancreas: Typical and Atypical Manifestations

Jin-Young Choi1,2,3, Myeong-Jin Kim1,2,4,5, Joo Hee Kim1,2, Seung Hyoung Kim1,2, Joon Sok Lim1,2, Young Taik Oh1,2, Jae-Joon Chung1,2, Hyung Sik Yoo1,2, Jong Tae Lee1,2 and Ki Whang Kim1,2

1 Department of Diagnostic Radiology, Yonsei University College of Medicine, Seodaemun-ku Shinchon-dong 134, Seoul 120-752, Korea.
2 Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea.
3 Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea.
4 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul 120-752, Korea.
5 Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, Korea.


Figure 1
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  		Fig. 1 —19-year-old woman with palpable abdominal mass of solid pseudopapillary tumor. Contrast-enhanced CT scan shows well-encapsulated heterogeneous mass (arrow) in tail of pancreas.

 

Figure 2
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  		Fig. 2A —20-year-old woman with palpable abdominal mass of solid pseudopapillary tumor. Axial T1-weighted gradient-echo image shows well-defined heterogeneous hyperintense mass with rim of low signal intensity (arrow) in head of pancreas.

 

Figure 3
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  		Fig. 2B —20-year-old woman with palpable abdominal mass of solid pseudopapillary tumor. Axial fast spin-echo T2-weighted image shows heterogeneous hyperintense mass in head of pancreas. Fibrous capsule appears as band of low signal intensity (arrow).

 

Figure 4
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  		Fig. 2C —20-year-old woman with palpable abdominal mass of solid pseudopapillary tumor. Unenhanced axial T1-weighted gradient-echo image shows hemorrhage as area of high signal intensity (arrow).

 

Figure 5
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  		Fig. 2D —20-year-old woman with palpable abdominal mass of solid pseudopapillary tumor. Delayed phase axial T1-weighted gradient-echo image obtained after gadolinium administration shows heterogeneous enhancement (arrow) of solid portion of mass.

 

Figure 6
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  		Fig. 3A —28-year-old woman with intermittent abdominal pain for 2 months and pancreatic and cystic mass in liver. Surgical resection of liver confirmed presence of metastatic solid pseudopapillary tumor. Contrast-enhanced CT scan shows mass (white arrow) in tail of pancreas with peripheral calcification (black arrow).

 

Figure 7
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  		Fig. 3B —28-year-old woman with intermittent abdominal pain for 2 months and pancreatic and cystic mass in liver. Surgical resection of liver confirmed presence of metastatic solid pseudopapillary tumor. CT scan shows cystic mass (arrow) with focal solid portion in liver.

 

Figure 8
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  		Fig. 3C —28-year-old woman with intermittent abdominal pain for 2 months and pancreatic and cystic mass in liver. Surgical resection of liver confirmed presence of metastatic solid pseudopapillary tumor. Fast spin-echo T2-weighted image shows fluid-fluid level within mass (arrow), indicating hemorrhage.

 

Figure 9
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  		Fig. 3D —28-year-old woman with intermittent abdominal pain for 2 months and pancreatic and cystic mass in liver. Surgical resection of liver confirmed presence of metastatic solid pseudopapillary tumor. Delayed contrast MR image reveals encapsulation of mass (arrow).

 

Figure 10
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  		Fig. 3E —28-year-old woman with intermittent abdominal pain for 2 months and pancreatic and cystic mass in liver. Surgical resection of liver confirmed presence of metastatic solid pseudopapillary tumor. Delayed MR image of liver shows cystic mass (arrow) with focal solid component. Differential diagnoses of cystic metastasis and biliary cystadenoma were considered.

 

Figure 11
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  		Fig. 3F —28-year-old woman with intermittent abdominal pain for 2 months and pancreatic and cystic mass in liver. Surgical resection of liver confirmed presence of metastatic solid pseudopapillary tumor. Fast spin-echo T2-weighted image of liver shows well-marginated, hemorrhagic, cystic and solid mass (arrow).

 

Figure 12
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  		Fig. 4A —56-year-old woman with elevated aspartate aminotransferase and alanine aminotransferase levels. Axial T1-weighted MR image shows heterogeneous mass (arrow) in pancreatic tail with areas of high signal intensity suggesting hemorrhage.

 

Figure 13
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  		Fig. 4B —56-year-old woman with elevated aspartate aminotransferase and alanine aminotransferase levels. Coronal T2-weighted MR image shows well-marginated mass (large arrow) arising from tail of pancreas. Multiple hepatic metastatic lesions (small arrows) are evident.

 

Figure 14
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  		Fig. 5A —43-year-old woman with dyspepsia and solid pseudopapillary tumor with ductal obstruction. Transverse sonogram shows hypoechoic mass (arrow) in head of pancreas.

 

Figure 15
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  		Fig. 5B —43-year-old woman with dyspepsia and solid pseudopapillary tumor with ductal obstruction. Axial CT scan of pancreas obtained in arterial phase reveals ill-defined low-density mass (arrow) in head of pancreas. Focal calcification is present within mass.

 

Figure 16
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  		Fig. 5C (continued)—43-year-old woman with dyspepsia and solid pseudopapillary tumor with ductal obstruction. CT scan shows marked dilatation (arrows) of main pancreatic duct.

 

Figure 17
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  		Fig. 5D (continued)—43-year-old woman with dyspepsia and solid pseudopapillary tumor with ductal obstruction. Photograph of surgical specimen shows infiltrative solid mass (arrow) in head of pancreas. Pancreatic duct was occluded by solid mass, and upstream pancreatic duct was dilated.

 

Figure 18
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  		Fig. 6A —42-year-old woman with pancreatic mass found incidentally on imaging. Axial CT scan of pancreas shows encapsulated mass with peripheral calcification and focal extracapsular extension (arrow).

 

Figure 19
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  		Fig. 6B —42-year-old woman with pancreatic mass found incidentally on imaging. T1-weighted gradient-echo image of pancreas shows heterogeneous mass (arrow).

 

Figure 20
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  		Fig. 6C (continued)— 42-year-old woman with pancreatic mass found incidentally on imaging. Axial fast spin-echo T2-weighted image at same level as B shows solid and cystic mass (arrow).

 

Figure 21
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  		Fig. 6D (continued)— 42-year-old woman with pancreatic mass found incidentally on imaging. Axial T1-weighted gradient-echo image obtained in delayed phase of enhancement shows extracapsular extension (arrow) of tumor.

 

Figure 22
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  		Fig. 6E (continued)— 42-year-old woman with pancreatic mass found incidentally on imaging. Photograph of gross pathologic specimen shows focal pericapsular extension (arrow).

 

Figure 23
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  		Fig. 7A —56-year-old man with pancreatic mass found incidentally at sonography. Axial T1-weighted MR image shows low-signal-intensity mass (arrow) in head of pancreas.

 

Figure 24
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  		Fig. 7B —56-year-old man with pancreatic mass found incidentally at sonography. Axial T2-weighted MR image obtained at same level as A shows mass (arrow) of heterogeneous signal intensity.

 

Figure 25
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  		Fig. 7C —56-year-old man with pancreatic mass found incidentally at sonography. Axial T1-weighted MR image obtained in arterial phase shows hypervascular mass (arrow).

 

Figure 26
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  		Fig. 8A —44-year-old woman with pancreatic mass found on sonography. Radiograph shows curvilinear calcification (arrow) in left upper quadrant of abdomen.

 

Figure 27
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  		Fig. 8B —44-year-old woman with pancreatic mass found on sonography. Transverse sonogram shows dense peripheral rim calcification with posterior acoustic shadowing (arrow).

 

Figure 28
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  		Fig. 8C (continued)—44-year-old woman with pancreatic mass found on sonography. Unenhanced CT scan shows peripheral curvilinear calcification (thin arrow) and internal hemorrhage (wide arrow).

 

Figure 29
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  		Fig. 8D (continued)—44-year-old woman with pancreatic mass found on sonography. Axial CT scan shows heterogeneous mass (arrow) with calcification.

 

Figure 30
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  		Fig. 9A —58-year-old woman with pancreatic mass on sonography. Axial CT shows extensive, dense, calcified mass (arrow) in body of pancreas.

 

Figure 31
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  		Fig. 9B —58-year-old woman with pancreatic mass on sonography. Coronal reformatted CT scan shows dense, thick, peripheral calcification (arrow).

 

Figure 32
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  		Fig. 10A —41-year-old man with abdominal pain. Axial CT scan of pancreas obtained in parenchymal phase of enhancement shows heterogeneous mass with peripheral rim enhancement (arrow).

 

Figure 33
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  		Fig. 10B —41-year-old man with abdominal pain. Axial T1-weighted gradient-echo image shows hypointense mass (arrow) in tail of pancreas.

 

Figure 34
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  		Fig. 10C (continued)—41-year-old man with abdominal pain. Axial T2-weighted image shows heterogeneous hyperintense mass (arrow).

 

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