0:01

So another case, case of the pancreatic

0:02

lesion, and as we go through the coronal

0:05

images, we see lots of lesions in both kidneys.

0:10

And most of these lesions are showing

0:12

T2-weighted hyperintensity, but some of

0:15

these lesions are having mixed intensity

0:18

with peripheral hypointensity as well.

0:20

Some of these lesions are big and

0:22

exophytic, and some of these lesions

0:25

are small, and they are showing acute

0:27

angulation formed with the parenchyma.

0:29

Which is called as angular interface sign.

0:33

Whenever you see interface sign or acute

0:36

angulation formed by a lesion with the parenchyma,

0:39

they are most likely going to be benign.

0:42

Let us see them in the axial first and

0:44

make sure that we are not missing anything.

0:46

This is the pancreatic

0:47

lesion we are talking about.

0:49

This is the lesion which is well-circumscribed,

0:51

well-defined with central necrosis with

0:54

peripheral thick rim and then the duct is

0:57

seen along with the periphery of this lesion.

1:01

It is slightly dilated distally because

1:03

of the mass effect caused by this lesion.

1:05

But duct proximal is looking normal

1:08

and those lesions in the kidneys are

1:10

again seen, they are hyperintense.

1:13

Some of these are exophytic and they are showing

1:15

some kind of hypointense tissue at the periphery.

1:18

So let's open fat suppress T2 here and see

1:23

how these lesions in the kidney are behaving

1:25

and most of these lesions now become T2

1:28

weighted hypointense with the fat suppression.

1:31

So that means most of these lesions are basically

1:33

angiomyolipomas and the soft tissue component

1:36

which we have seen in some of the lesions above,

1:38

still present, but the lesion in the

1:42

periphery is showing fat suppression,

1:45

so that is also angiomyolipoma.

1:47

So remember, angiomyolipoma has

1:49

three components: angio, myo, lipoma.

1:53

Angio means it is composed of

1:55

blood vessels, blood component.

1:58

Myo means it has a component of musculature,

2:00

and lipoma means it has the fat.

2:03

So it is possible one of the angiomyolipoma

2:05

may have a dominant component of the

2:07

fat, and one of them might have

2:10

dominant component of the musculature or muscle

2:12

tissue, or spindled cells, or smooth muscles.

2:16

So if we see this kind of appearance,

2:18

it is possibly a mixed kind of angiomyolipoma,

2:20

which has both angio, myo,

2:23

and lipoma content dominant.

2:25

Angio component, will be seen better on the

2:28

post-contrast images, which we see can,

2:31

we can see there are like some vessels

2:33

inside, tortuous vessels inside

2:35

and that area of enhancement.

2:38

But based on the T2-weighted images,

2:40

these kidney lesions are angiomyolipomas.

2:43

Let us come back to the

2:44

main point, the lesion in the pancreas.

2:48

We see a lesion during the arterial

2:50

phase, which is enhancing along with the

2:53

periphery and demonstrates central necrosis.

2:57

And do we have hemorrhagic

2:58

component inside this lesion?

2:59

There is some focus of hyperintensity,

3:03

but most of the lesion is looking hypointense.

3:06

And how it behaves on the venous phase?

3:09

During the venous phase, we still see

3:11

the enhancement along with the periphery,

3:13

which is kind of irregular, and the

3:15

duct is not significantly dilated.

3:18

So, here the differential remains between

3:20

SPN and Necrotic Neuroendocrine Tumor.

3:25

So, this is a male patient and the tumor is situated

3:28

in the mid of the pancreas or in the body,

3:32

and we did not see significant hemorrhagic

3:35

component within the tumor itself, though there

3:38

is necrosis which is better seen on T2-weighted

3:40

images, and the component of necrosis did not

3:44

enhance much and the periphery enhancing, almost

3:48

similar to the pancreatic parenchyma.

3:50

So, the differential still remains SPN

3:52

versus neuroendocrine tumor,

3:54

which has undergone cystic necrosis.

3:56

So, this was actually a case of cystic necrosis

3:59

of neuroendocrine tumor in the pancreas.

4:03

But it looks like SPN. If this patient is

4:06

young, around 20-30 years old, and female,

4:08

I would go with SPN. But given the differential

4:11

of cystic neuroendocrine tumor together,

4:15

and biopsy will be conclusion in this case.