Pancreatic hemangioma: Imaging features with contrast-enhanced CT and with gadolinium- and mangafodipir-enhanced MRI

https://doi.org/10.1016/j.ejrex.2005.11.008Get rights and content

Abstract

Pancreatic hemangioma is an extremely rare tumor, with only a very few cases reported in the literature. We present the case of a 36-year-old man admitted to the hospital with jaundice and abdominal pain. Contrast-enhanced CT showed a hypervascular mass with large vessels in the pancreatic head. The mass appeared moderately hypervascular on gadolinium-enhanced MRI, and, on mangafodipir-enhanced MRI, no contrast agent uptake into the mass could be detected. Despite the size of the lesion, no dilatation of the pancreatic and the common bile duct were seen. Pancreatic hemangioma should be included in the list of differential diagnoses in case of a hypervascular pancreatic lesion without signs of mass effect.

Introduction

Hypervascular tumors such as hemangioma are frequently seen in the liver but appear very rarely in the pancreas [1]. To our knowledge up to now less than 10 cases have been reported in the literature [2], [3], [4], [5]. Pancreatic hemangiomas have been reported to be large, non-invasive and well enhancing tumors [3]. Ultrasound, CT and MRI features of hemangiomas have been described previously. In our case, we describe the MRI features of a hemangioma of the pancreatic head after IV application of gadolinium and of the liver- and pancreas-specific contrast agent mangafodipir.

Section snippets

Case report

A 36-year-old man was referred to our hospital for upper abdominal pain. Past medical history was not significant. Serological studies were normal except for slightly elevated gamma-GT (99 U/l), tumor markers were within normal range. Endoscopy of the stomach and duodenum revealed duodenal ulcer. Contrast-enhanced CT of the abdomen showed a hypervascular 3 cm mass with large vessels in the pancreatic head (Fig. 1). In addition, a hypervascular lesion was found in segment II of the liver. A

Discussion

Non-epithelial tumors of the pancreas account for only 1–2% of all pancreatic neoplasms [1]. Among them, vascular tumors of the pancreas are even rarer, including hemangioma, lymphohemangioma, hemangioendothelioma, hemangiopericytoma, and angiosarcoma. Less than 10 cases of pancreatic hemangioma have been reported in the literature between 1966 and 2003 [2], [3], [4], [5]. The CT and plain MRI features of a very few cases have been reported in the literature [2], [3].

Pancreatic hemangiomas have

References (22)

  • E. Paal et al.

    A clinicopathologic and immunohistochemical study of ten pancreatic lymphangiomas and a review of the literature

    Cancer

    (1998)
  • N. Tebboune et al.

    Pancreatic hemangioma in infancy: the place of radiology

    Pediatr Radiol

    (2003)
  • H. Kobayashi et al.

    Pancreatic cavernous hemangioma: CT, MRI, US and angiography characteristics

    Gastrointest Radiol

    (1991)
  • J. Dageforde et al.

    Hemangioma of the pancreas

    RoFo

    (1991)
  • P. Mangin et al.

    Hemangioma of the pancreas

    J Radiol

    (1985)
  • C. Bartolozzi et al.

    Focal liver lesions: MR imaging-pathologic correlation

    Eur Radiol

    (2001)
  • G.L. Bennett et al.

    Addition of gadolinium chelates to heavily T2-weighted MR imaging: limited role in differentiating hepatic hemangiomas from metastases

    AJR

    (2000)
  • H.B. Gehl et al.

    Pancreatic enhancement after low-dose infusion of Mn-DPDP

    Radiology

    (1991)
  • W. Schima et al.

    Evaluation of focal pancreatic masses: comparison of mangafodipir-enhanced MR imaging and contrast-enhanced helical CT

    Eur Radiol

    (2002)
  • A.K. Hamoud et al.

    Mangan-enhanced MR imaging for the detection and localisation of small pancreatic insulinoma

    Eur Radiol

    (2004)
  • D. Sahani et al.

    Functioning acinar cell pancreatic carcinoma: diagnosis on mangafodipir trisodium (Mn-DPDP)-enhanced MRI

    J Comput Assist Tomogr

    (2002)
  • Cited by (14)

    • Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review

      2018, Seminars in Ultrasound, CT and MRI
      Citation Excerpt :

      However, other reports demonstrate that because of the presence of areas of neovascularization with arteriovenous shunting, the blood flow through these cavernous vascular components may be slow, resulting in diminished contrast enhancement on arterial phase CT.61,64,65 Therefore, poor arterial phase enhancement on contrast-enhanced CT should not rule out a pancreatic hemangioma, and the signal intensity features observed on MRI should be a valuable corroborative finding to support this diagnosis.61,64,65 When the tumor has a hypervascular component, main differential diagnoses include lymphangioma, hemangioendothelioma, hemangiopericytoma, and angiosarcoma, neuroendocrine tumors and metastases.66 Intrapancreatic aneurysms and pseudoaneurysms may simulate a solid, hypervascular mass like a neuroendocrine tumor, or, when associated with thrombosis or hemorrhage, even a pancreatic carcinoma.67-71

    • Pancreatic hemangioma mimicking a malignant pancreatic cyst

      2011, Gastrointestinal Endoscopy
      Citation Excerpt :

      On imaging, the absence of strong contrast enhancement on the arterial phase CT scan, as is found in typical hemangiomas, has been attributed to arteriovenous shunting within cystic pancreatic tumors, causing slow blood flow.5 Of the 6 cases of pancreatic hemangioma with contrast-enhanced CT imaging to date, 5 cases (including ours) demonstrated this absence.5,7-9 EUS with FNA has been described as the most accurate modality for the diagnosis of pancreatic cysts.

    • Answer to november e-quid

      2007, Journal de Radiologie
    View all citing articles on Scopus
    View full text