0:01

So, another case of pancreatic lesion here,

0:04

and on T2-weighted images, as we scroll through,

0:07

the pancreas grossly looks normal, the pancreatic

0:09

duct is not dilated, but as soon as we reach

0:12

to the uncinate process, we see a lesion which

0:15

is T2-weighted, intermediate to hyperintense.

0:18

So, this lesion, which looks very well-defined.

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Usually, these well-defined lesions

0:22

are neuroendocrine tumors, and they

0:25

also look heterogeneously T2-weighted,

0:26

hyperintense or intermediate.

0:29

But is it really a neuroendocrine tumor?

0:31

Let us find it.

0:32

On DWI image, we see a small hyperintensity

0:37

in the liver and as we go downwards towards the

0:40

uncinate process, nothing significant is seen.

0:43

On non-fat suppressed T2, we see that hyper

0:46

intensity which we have seen on DWI here as

0:49

well and then pay attention to that area if

0:53

we find a real lesion, which is tough to find

0:55

on non-fat suppressed images, possibly here.

1:01

Let's see how it behaves on the arterial phase.

1:03

If it is a neuroendocrine tumor,

1:04

it should enhance in the arterial phase.

1:07

During the arterial phase, this lesion is

1:10

actually not enhancing, it is rather hypointense,

1:11

so it is not a neuroendocrine tumor.

1:15

A hypo-enhancing lesion which is well-defined,

1:18

confined to the uncinate process of the pancreas

1:21

and how it behaves on the delayed phase.

1:23

As we go to the delayed phase and pay attention

1:26

to that area, we see that the lesion is enhancing

1:30

in the delayed phase, but it is well-defined.

1:33

It does not cause any mass effect over

1:36

the underlying organs or the vasculature.

1:39

There is no fat stranding.

1:41

There is no involvement of any

1:43

vessels in the surrounding.

1:44

So overall, this lesion is behaving very

1:45

benign, but it is not behaving the way

1:49

the neuroendocrine tumor should behave.

1:51

Let's go back and look at the hypo-

1:54

hyperintensity we have seen previously on other

1:58

sequences in the liver. So this was a high

2:02

hyperintensity on the arterial phase, which

2:04

just disappears on the delayed venous phase.

2:07

So basically, this is a Duma there,

2:10

so nothing to worry about that area.

2:13

So there is no metastasis, the lesion

2:15

which we have seen in the liver was just

2:16

a hemangioma. Just ignore it, it is better

2:20

seen here with the nodular puddling or

2:23

nodular enhancement along with the periphery.

2:26

But during the venous phase, that lesion in the

2:28

pancreas looks very well-defined, specifically in

2:32

the delayed phase, and it is behaving very well.

2:36

So it is not invading

2:37

anything in the neighborhood.

2:40

So what is the diagnosis here?

2:41

So remember, pancreas has some of the structures

2:43

in the neighborhood, those may include nerves

2:47

And tumors can arise from the nerves as well.

2:48

So this was actually a nerve

2:50

sheath tumor, a schwannoma.

2:52

It was biopsied, it was proven benign schwannoma

2:55

and nothing was done on this patient.