Sandbox: DDx pancrease

Solid pseudopapillary neoplasms

• 20 year old female
• asymptomatic
• large, solitary, well-circumscribed lesions
• mixed cystic and solid
• equally distributed throughout the pancreas

• polygonal cells
• Multiple capillary-size vessels
• pseudopapillary appearance

Characteristics	Insulinoma	Vipoma	Gastrinoma
Symptoms
Diaphoresis	Present	Absent	Absent
Watery diarrhea	Absent	Present	Absent
Heartburn	Absent	Absent	Present
Lab values
Hypoglycemia	Present	Absent	Absent
Hypokalemia	Absent	Present	Absent
Hypergastrinemia	Absent	Absent	Present
CT scan	Calcification and hyperattenuation of the mass	Hypervascularity with diffuse multiple metastatic nodulation	Small hypoattenuating nodule ± calcification
Histopathology	Solid or gyriform cellular patterns with amyloid deposition, absence of glands, and nesidioblastosis	Solid sheets with uniform cuboidal cells, centrally located nuclei, and granular cytoplasm	Lobular-trabecular pattern of gastrin positive tumor cells with infiltration of Brunner glands