Interactive Transcript
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So, another case of pancreatic lesion here,
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and on T2-weighted images, as we scroll through,
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the pancreas grossly looks normal, the pancreatic
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duct is not dilated, but as soon as we reach
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to the uncinate process, we see a lesion which
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is T2-weighted, intermediate to hyperintense.
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So, this lesion, which looks very well-defined.
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Usually, these well-defined lesions
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are neuroendocrine tumors, and they
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also look heterogeneously T2-weighted,
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hyperintense or intermediate.
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But is it really a neuroendocrine tumor?
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Let us find it.
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On DWI image, we see a small hyperintensity
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in the liver and as we go downwards towards the
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uncinate process, nothing significant is seen.
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On non-fat suppressed T2, we see that hyper
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intensity which we have seen on DWI here as
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well and then pay attention to that area if
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we find a real lesion, which is tough to find
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on non-fat suppressed images, possibly here.
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Let's see how it behaves on the arterial phase.
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If it is a neuroendocrine tumor,
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it should enhance in the arterial phase.
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During the arterial phase, this lesion is
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actually not enhancing, it is rather hypointense,
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so it is not a neuroendocrine tumor.
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A hypo-enhancing lesion which is well-defined,
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confined to the uncinate process of the pancreas
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and how it behaves on the delayed phase.
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As we go to the delayed phase and pay attention
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to that area, we see that the lesion is enhancing
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in the delayed phase, but it is well-defined.
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It does not cause any mass effect over
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the underlying organs or the vasculature.
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There is no fat stranding.
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There is no involvement of any
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vessels in the surrounding.
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So overall, this lesion is behaving very
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benign, but it is not behaving the way
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the neuroendocrine tumor should behave.
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Let's go back and look at the hypo-
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hyperintensity we have seen previously on other
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sequences in the liver. So this was a high
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hyperintensity on the arterial phase, which
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just disappears on the delayed venous phase.
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So basically, this is a Duma there,
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so nothing to worry about that area.
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So there is no metastasis, the lesion
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which we have seen in the liver was just
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a hemangioma. Just ignore it, it is better
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seen here with the nodular puddling or
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nodular enhancement along with the periphery.
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But during the venous phase, that lesion in the
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pancreas looks very well-defined, specifically in
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the delayed phase, and it is behaving very well.
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So it is not invading
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anything in the neighborhood.
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So what is the diagnosis here?
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So remember, pancreas has some of the structures
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in the neighborhood, those may include nerves
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And tumors can arise from the nerves as well.
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So this was actually a nerve
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sheath tumor, a schwannoma.
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It was biopsied, it was proven benign schwannoma
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and nothing was done on this patient.
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