1. CASE OF THE MONTH April 2018 M. Granholm, MD, MPH
PGY2 Diagnostic Radiology
McMaster University

2. Clinical History 21 year old female, vague abdominal pain
No previous imaging available

3. CT

4. Findings

5. Findings
Solid and cystic (white solid arrow) mass within dense rim calcifications (white curved arrow)

6. Ultrasound

8. Findings

9. Findings
Large well-defined mass with heterogeneous appearances, due to its solid (white solid arrow) and cystic (black curved arrow) composition

10. Solid and Pseudopapillary Epithelial Neoplasm
SPEN

12. Solid and Pseudopapillary Epithelial Neoplasm The Highlights
Classically, young non-Caucasian woman (20s-30s)
Well-defined, heterogeneous, large pancreatic mass with thick, enhancing capsule
Solid most commonly, but can have variable cystic components and intratumoral hemorrhage
Internal hemorrhage (fluid-fluid or hematocrit levels)
HIGHLY characteristic feature
Peripheral or central calcifications (45-50%)
No biliary or pancreatic ductal obstruction (usually)

13. Solid and Pseudopapillary Epithelial Neoplasm Clinical Presentation
If symptomatic
Vague abdominal pain

14. Solid and Pseudopapillary Epithelial Neoplasm Complications
Hemorrhage
Biliary obstruction

15. Solid and Pseudopapillary Epithelial Neoplasm Treatment
Complete surgical resection
Associated with long-term survival even in the presence of metastatic disease

16. References
Raman, P. (2018). Pancreatic solid and pseudopapillary neoplasm. pseudopapilla-/fab c-4afd-8b eb8517dd9?searchTerm=SPEN
Weerakkody, Y. et al. (2018). Solid pseudopapillary tumor of the pancreas. Radiopedia, available from: the-pancreas-1