Objectives

A primer of pancreatic neuroendocrine tumours (PanNET) tumours, including:

- Imaging features of PanNETs

- Staging and assessment of PanNET using a multi-modality imaging approach

- Functional tumours: biochemical pathways that link hormone secretion to classic symptoms and imaging features

- PanNET genetic predisposition syndromes

Background

PanNETs comprise 2-10% of pancreatic tumours. A minority of PanNETs are functional (10%), producing symptoms related to secretion of hormones or active polypeptides. Functional PanNETs encompass insulinomas (35-40%); gastrinomas (15-30%); and glucagonomas / VIPomas / somatostatinomas (rare). Genetic predisposition syndromes increase the likelihood of developing a PanNET with the most common of these being multiple endocrine neoplasia-1

Imaging findings OR Procedure findings

The assessment of PanNET requires a multi-modality imaging approach which may include the complimentary use of CT, MRI, EUS and radionuclide imaging. PanNETs may demonstrate imaging features that relate to their hormone profile and patient symptoms. Evaluation for such features can help direct symptom management. The location of a PanNET can vary depending on the subtype, for example gastrinomas more commonly arise from the duodenum than the pancreas. Additionally, patients can present with multiple gastrinomas. Atypical imaging features of PanNETs such as cystic change are often identified, particularly in the context of genetic predisposition syndromes

Conclusion

PanNETs have variable malignant potential. They can produce a variety of symptoms and imaging features depending on whether they are functional. Genetic predisposition syndromes increase the likelihood of developing a PanNET, including MEN-1, VHL and uncommonly NF-1 and TS. The role of imaging is essential in characterising lesions, staging, prognostication, and follow-up.

Objectives

To review the appearances of intra-abdominal desmoid tumours across multiple imaging modalities

To examine pitfalls in the evaluation of extent of disease, in particular local invasion, so as to aid decisions regarding organs needed to transplant.

To appreciate resection considerations including; localising tumours to abdominal compartments and vascular considerations.

Background

Desmoid tumours are fibroblastic tumours most commonly arising from the mesentery, retroperitoneum or abdominal wall. Whilst they are benign lesions, they demonstrate extensive local invasion and often recur.

As a transplant centre we see a cohort of patients with advanced abdominal desmoid tumours who will require small bowel transplant (SBT) or multi visceral transplant (MVT) to allow resection.

Imaging findings OR Procedure findings

We will present desmoid tumour imaging characteristics at MR & CT including tumour morphology, common intra-abdominal sites and patterns of organ involvement. With case examples, we discuss important resection considerations and imaging pitfalls. Given the extensive local invasion of these tumours, we will review peritoneal compartment anatomy alongside different surgical transplant options required to support resection.

Patients with desmoid tumours often have an array of additional imaging findings associated with their underlying co-morbidity, for example, patients with Gardner’s syndrome develop adenomatous polyps, diffuse fibromatosis and osteomas.

Following extensive multivisceral resection and transplantation we review post operative imaging findings and complications.

Conclusion

Resection of locally advanced desmoid tumours requires close interaction of radiology and surgical teams. We will discuss pertinent imaging findings and pitfalls in interpretation, reviewing imaging in conjunction with surgical findings following extensive resections.

Objectives

A primer of pancreatic neuroendocrine tumours (PanNET) tumours, including:

- Imaging features of PanNETs

- Staging and assessment of PanNET using a multi-modality imaging approach

- Functional tumours: biochemical pathways that link hormone secretion to classic symptoms and imaging features

- PanNET genetic predisposition syndromes

Background

PanNETs comprise 2-10% of pancreatic tumours. A minority of PanNETs are functional (10%), producing symptoms related to secretion of hormones or active polypeptides. Functional PanNETs encompass insulinomas (35-40%); gastrinomas (15-30%); and glucagonomas / VIPomas / somatostatinomas (rare). Genetic predisposition syndromes increase the likelihood of developing a PanNET with the most common of these being multiple endocrine neoplasia-1

Imaging findings OR Procedure findings

The assessment of PanNET requires a multi-modality imaging approach which may include the complimentary use of CT, MRI, EUS and radionuclide imaging. PanNETs may demonstrate imaging features that relate to their hormone profile and patient symptoms. Evaluation for such features can help direct symptom management. The location of a PanNET can vary depending on the subtype, for example gastrinomas more commonly arise from the duodenum than the pancreas. Additionally, patients can present with multiple gastrinomas. Atypical imaging features of PanNETs such as cystic change are often identified, particularly in the context of genetic predisposition syndromes

Conclusion

PanNETs have variable malignant potential. They can produce a variety of symptoms and imaging features depending on whether they are functional. Genetic predisposition syndromes increase the likelihood of developing a PanNET, including MEN-1, VHL and uncommonly NF-1 and TS. The role of imaging is essential in characterising lesions, staging, prognostication, and follow-up.