20171214英文大读片

Good morning teachers. Today we will discuss two cases and review one case.
Now let’s start with the first one
The first case is about a fifty-year-old male patient and he has experienced abdominal gas pains repeatedly for 12 months.
Two weeks ago, the ultrasonic test indicated a cystic and solid mass located in his pancreas.
His tumor markers and other test results are all normal. Let’s review his MRI findings now.
On T2WI, we can find a well-defined solid-cystic lesion, which is located in the tail of pancreas. The lesion shows slight hyper and hyper intensity. The pancreatic duct is not expanding and not connected with the lesion.
On DWI, the lesion shows heterogeneous hyper intensity. and two swollen lymph nodes can be seen next to the stomach.
There is a slighter signal drop on out phase.
On T1WI, the lesion shows/is of heterogeneous hypointensity .
In the early arterial phase, the solid part of the lesion shows slight heterogeneous enhancement.
In the late arterial phase, the solid part and the margin of the lesion shows continued enhancement.
In the portal phase（门脉期）, the lesion still shows slight enhancement.
On coronal view, the solid part shows enhancement.
In the delayed phase, the lesion still shows enhancement.

This is a 50Y male patient who had a heterogeneous long-T1 and long-T2 signal lesion with restricted diffusion and progressive enhancement in the tail of pancreas.
The lesion did not invade the surrounding blood vessels.

In my opinion, this is a solid-cystic tumor of pancreas, and Solid Pseudopapillary Neoplasm is my first choice of diagnosis. Because the lesion was encapulated and did not invade the surrounding blood vessels. In addition, the lesion shows progressive enhancement.
As for differential diagnosis, I think pancreatic neuroendocrine tumor should also be taken into consideration. But There is sharper/more marked enhancement in the tumor on arterial phase than on other phases.
We should also think about the cystadenoma of pancreas, but generally , the tumor shows low-signal on ADC map.
I will appreciate it if teachers can give your opinions about the case freely. Thanks for your attention.

早上好老师今天, 我们将讨论两个案件, 并审查一个案件。 现在让我们开始第一个病例是关于一个五十 year-old 的男性病人, 他经历了12月的腹部气体疼痛反复。 两周前, 超声检查显示在他的胰腺中有囊性和坚固的肿块。 他的肿瘤标记和其他测试结果都是正常的。现在我们来回顾一下他的核磁共振结果。 在 T2WI, 我们可以找到一个明确的实体囊性病变, 这是位于胰尾部。病灶呈轻度超强强度。胰管不扩大, 与病变不相连。 在 DWI 上, 病灶呈异质性超强。在胃旁可以看到两个肿大的淋巴结。 有一个轻信号下降的阶段。 在 T1WI, 病变显示/是异构低。 在早期动脉期, 病灶的实体部分呈轻度异质性增强。 在晚期动脉期, 病灶的固体部分和边缘显示持续增强。 在门阶段 (门脉期), 病灶仍有轻微的增强。 在日冕上, 固体部分显示增强。 在延迟阶段, 病灶仍显示增强。 这是一个50Y 的男性患者谁有一个异构的 long-T1 和 long-T2 信号病变的限制扩散和渐进增强在尾部胰腺。 病灶没有侵入周围的血管。 在我看来, 这是一个胰腺的实性囊性肿瘤, 而坚实的 Pseudopapillary 肿瘤是我的首选诊断方法。因为病灶是 encapulated 的, 并没有侵入周围的血管。此外, 病变显示渐进增强。 至于鉴别诊断, 我认为也应该考虑胰腺神经内分泌肿瘤.但在动脉相较于其他阶段, 肿瘤有明显的增强。 我们也应该考虑胰腺的瘤, 但一般情况下, 肿瘤在 ADC 图谱上显示 low-signal。 如果老师能自由地发表你对这个案子的意见, 我将不胜感激。谢谢你的关注。