J Korean Med Sci.  2011 Jun;26(6):832-835. 10.3346/jkms.2011.26.6.832.

Synchronous Ectopic Pancreatoblastoma in a Child: A Case Report

Affiliations
  • 1Department of Radiology, the First Affiliated Hospital of ZhengZhou University, Zhengzhou, Henan, China. yangzhihao1365380@126.com

Abstract

Pancreatoblastoma is a rare primary pancreatic neoplasm of children that may arise in any portion of the pancreas. We report a case of a 3-yr-old boy who presented to with abdominal pain our hospital and a progressive bulge in his right abdomen. Biochemical evaluation and serum levels of tumoral markers were within reference limits. On the computed tomography, two tumors were found. One located in the head of the pancreas; however, a laparotomy revealed that the head of pancreas was compressed but normal. The other was in the left abdomen near the spleen and the tail of the pancreas. The diagnosis of two synchronous pancreatoblastoma originating from the omentum was confirmed by pathology. Therefore, a pancreatoblastoma should be considered when a large well-defined, lobulated, and heterogeneous mass is identified in the pancreas of children. In addition, an ectopic pancreatoblastoma should be considered when identified within or near the ectopic pancreatic tissue.

Keyword

Pancreatic Neoplasms; Pancreatoblastoma; Ectopic; CT; Child

MeSH Terms

Antineoplastic Agents/therapeutic use
Child, Preschool
Drug Therapy, Combination
Humans
Laparotomy
Male
Pancreatic Neoplasms/drug therapy/*pathology/surgery
Peritoneal Neoplasms/drug therapy/pathology/surgery
Tomography, X-Ray Computed

Figure

  • Fig. 1 CT findings of the pancreatoblastoma in a 3-yr-old boy. On non-contrast CT (A) two tumors were noticed, the primary lesion (black arrow) located in the head of the pancreas, and partly herniated into the abdominal wall. While the secondary lesion (white arrow) is in the left abdomen near the spleen and the tail of pancreas, and well demarcated from the surrounding structures. They all showed inhomogeneous attenuation and no calcifications were evident within the mass. On dynamic CT scanning (B) arterial phase; (C) portal phase; (D, E) delayed phase. The tumors were inhomogenously enhanced, in the venous phase and delayed phase. A continuous enhancement was observed with the parenchyma density higher than that of arterial phase. In addition, a large and distorted vascular shadow (arrow) inside the tumors in arterial phase was in the primary lesion. Although the head of pancreas was firmly replaced with well-defined margins, the dilatation of the intrahepatic biliary tree and main pancreatic duct were not visible. Portal vein and the inferior vena cava were also compressed but patent. Five months after a complete tumors resection, a transverse CT image (F) demonstrates a normal pancreas (arrow), which is homogeneous and slightly hypodense relative to the liver. Moreover, there was no radiological evidence of nodal or liver metastases.

  • Fig. 2 Photomicrograph of the resected pancreatoblastoma. (A, B) The original tumor was mainly composed of neoplastic cells in acini-like structures (original magnification; H&E stain, × 100 and × 200 respectively). (C, D) A typical pancreatoblastoma of the secondary lesion (original magnification; H&E stain, × 100 and × 200 respectively) demonstrates an epithelial tumor with acinar formation, similar with the primary lesion.


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