Imaging Characteristics and Diagnostic Spectrum of Pancreatic Masses in Pediatric and Young Adult Patients: A Single-Center Retrospective Series
Imaging of Pediatric Pancreatic Masses
Keywords:
Solid pseudopapillary neoplasm, pediatric pancreatic mass, pancreatoblastoma, diffuse large B-cell lymphoma, neuroendocrine tumor, MRIAbstract
Objective: We aimed to describe the imaging characteristics and clinicopathologic features of pancreatic masses in pediatric and young adult patients managed at a single tertiary referral center.
Methods: This retrospective study included 19 patients (aged 4–24 years) with a pancreatic mass evaluated between 2012 and 2025. Cross-sectional imaging included computed tomography (n = 12), magnetic resonance imaging (MRI, n = 16), or both (n = 10). Imaging findings, pathologic results, and surgical outcomes were analyzed descriptively.
Results: Solid pseudopapillary neoplasm (SPN) was the most common diagnosis (n = 12, 63.2%), predominantly affecting female patients (10/12, 83.3%), with a median age of 14 years (range 12–17). A well-defined capsule was present in all 12 SPN cases (100%), and internal hemorrhage was present in 58.3%. Two of eleven MRI-evaluated SPN patients demonstrated an atypical, predominantly cystic pattern with absent T1 hyperintensity, no diffusion restriction, and no internal enhancement; both were preoperatively misinterpreted as pseudocysts. Main pancreatic duct dilatation was absent in all SPN cases, regardless of lesion size or location. Surgical resection was performed in 10 of 12 SPN patients (83.3%); lymphovascular invasion was absent in all confirmed cases. Rare entities included pancreatoblastoma (n = 1), diffuse large B-cell lymphoma with pancreatic involvement (n = 1), undifferentiated/anaplastic carcinoma (n = 1; the only case with nodal metastasis in the cohort), neuroendocrine tumor grade 1 (n = 1), focal nesidioblastosis (n = 1), serous cystadenoma (n = 1), and von Hippel-Lindau-associated pancreatic cysts (n = 1).
CONCLUSION: SPN accounts for approximately two-thirds of pancreatic masses in pediatric and young adult patients and displays characteristic imaging features that support a confident preoperative diagnosis. An atypical cystic SPN pattern mimicking a pseudocyst on MRI represents an underrecognized diagnostic pitfall. Rare entities have distinct , though sometimes overlapping, imaging appearances, and awareness of the full diagnostic spectrum is important for clinical management in this age group.
