PMC7759689_01
CT scan: a: The non-contrast phase showing a 10-cm low-density area in the posterior segment (triangle) and a 2-cm cystic lesion with capsule-like rim (arrow), b: the hepatic tumor showing heterogeneous hyper enhancement in the arterial phase, c: washout of the contrast enhancement during the delayed phase. The pancreatic lesion showing rim and intra-cystic component enhancement.
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The pancreatic cystic lesion seemed to have a capsule-like rim structure (Fig. 1).
a: The pancreatic lesion (arrow) showing an intra-cystic slit-shaped component on T1WI, b: high signal on T2WI, c, d: no abnormal signal on diffusion-weighted or apparent diffusion coefficient imaging.
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T2-weighted imaging (T2WI) of magnetic resonance imaging (MRI), the hepatic tumor showed a high signal intensity and mild diffusion restriction on diffusion-weighted imaging and apparent diffusion coefficient imaging. The pancreatic lesion displayed a high signal and slit-shaped low signal on T2WI (Fig. 2).
EOB-MRI: the hepatic tumor (triangle) demonstrated early enhancement with a poor-contrast central scar-like structure and washout during the portal venous and hepatobiliary phases. a: T1WI without contrast, b: arterial phase, c: portal venous phase, d: hepatobiliary phase. EOB-MRI: gadoxetic acid enhanced magnetic resonance imaging
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On gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) enhancement MRI (EOB-MRI), the hepatic tumor demonstrated early enhancement with a poor-contrast central scar-like structure and washout during the portal venous and hepatobiliary phases (20 min) (Fig. 3).
EUS: A 24-mm sized cystic lesion with lateral shadowing and isoechoic and anechoic components is observed. Communication between the cyst and the main pancreatic duct is not seen. Contrast-enhanced EUS shows distinct enhancement in the outer border of the cystic wall and solid inside component. EUS: endoscopic ultrasonography
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Tokyo, Japan) showed distinct enhancement in the outer border of the cystic wall and a solid inside component (Fig. 4). This lesion was suggestive of cystic degeneration of the solid neoplasm rather than the septal wall of cystic one.
Distal pancreatomy. The cystic neoplasm is growing not invasively but expansively to the adjacent pancreatic parenchyma. Small nests of endocrine tissue are present along the cystic wall. The superficial layers of endocrine cells are separated from the cystic lumen by a layer of fibrous tissue in continuity with the adjacent granulation tissue.
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Distal pancreatomy, posterior segmentectomy, and five-part enucleation of the small liver metastasis, which had not been detected on preoperative imaging, were performed (Fig. 5, 6).
Pancreatic cystic neoplasm histopathology. Hematoxylin and Eosin staining: a solid and trabecular growth pattern consisting of relatively uniform cells, finely granular eosinophilic cytoplasm, and centrally located round-to-oval nuclei that may demonstrate a distinct nucleolus (a). Immunostaining was negative for chromogranin A (b) and positive for CD56 (c) and synaptophysin (d).
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Distal pancreatomy, posterior segmentectomy, and five-part enucleation of the small liver metastasis, which had not been detected on preoperative imaging, were performed (Fig. 5, 6).
a: FDG-PET does not detect bone metastasis. b: SRS shows the abnormal accumulation in the second lumbar vertebra. c: Gadoxetic acid-enhanced MRI confirms a nodule with a contrast effect. FDG-PET: fluorodeoxyglucose-positron emission tomography, SRS: somatostatin receptor scintigraphy
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SRS and gadolinium-enhanced MRI detected an occult lumbar spine metastasis (Fig. 7).