Unusual Features in an Adult Pancreatic Hemangioma: CT and MRI Demonstration
In a 23-year-old woman with no symptoms, a 5.4 × 5.0 × 3.1 cm mass with internal heterogeneous hyperechogenicity in the pancreas head was found during an annual ultrasound health examination. Blood test findings were within normal range, including the complete blood count, liver function tests and tumor markers. The physical examination revealed no significant abnormality.\nCT was performed on a GE Lightspeed VCT scanner and included a plain scan and dual-phase enhanced scans respectively. CT parameters included 64 × 0.625 mm detector collimation, 120 kVp, 180 mAs, 1.0 pitch, 5 mm slice thickness. An enhanced scan using Iohexol (GE Healthcare, Shanghai, China) contrast agent during the arterial phase and portal venous phases (at 32 and 70 seconds, respectively, dose 1.5 mL/kg, injection flow rate 3.0 mL/s) were also performed. A plain CT scan of the abdomen showed a heterogeneous, well-defined mass at the pancreatic head. A contrast-enhanced CT scan revealed a heterogeneous, nonenhancing, multilocular cyst with fluid-fluid levels at the pancreatic head. The lesion grew outward and extended into the lesser sac ().\nMR imaging was performed with a SIEMENS 1.5-T superconducting system with a body coil. Sequences included T2-weighted fast spin echo with fat suppression (repetition time/echo time, 3250/110 msec; section thickness, 5 mm; gap, 1 mm) and T1-weighted breath-hold gradient echo (repetition time/echo time, 160/4.9 msec; section thickness, 5 mm; gap, 1 mm). A T1-weighted gradient-echo with fat suppression was performed during the hepatic arterial and portal venous phases (at 20 and 50 seconds, respectively) after manual administration of 0.1 mmol/kg Gadodiamide (GE Healthcare, Dublin, Ireland). The MR findings were similar to the CT findings. On MR, the superior fluid layer showed hyper signal intensity (SI) on T1WI and T2WI. The inferior fluid layer was slightly hyper SI to the pancreas on T1WI and hypo SI relative to the superior fluid layer on T2WI ().\nSubtotal pancreatectomy was done. At laparotomy, a soft, blood-red tumor was found arising from the head of the pancreas. There was no invasion of the surrounding vascular structures and the duodenum. The mass was resected from the pancreas. Gross pathologic examination revealed a reddish tumor composed of multiloculated cysts containing intracystic hemorrhaged blood. Microscopically, the tumor showed multiple vascular cysts of variable size lined by a single layer of uniformly flattened cells. The vascular cysts were separated by fibrous tissue (. Histologic examination was consistent with pancreatic hemangioma. The patient was healthy without any sign of recurrence oneyear after surgery.