Imaging Features Of Tumors Research Articles

Abdominal and Pelvic Tumors With Musculoskeletal Histology

This article is a case-based review of the broad spectrum of tumors with musculoskeletal histology that can arise in the abdomen or pelvis and involve the soft tissues, muscle, and bone. In this article, pathology-proven cases are presented with a focus on radiographic, computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography findings. The imaging features that differentiate tumors with musculoskeletal histology from more common abdominal tumors are discussed. Representative cases include malignant fibrous histiocytoma, chondrosarcoma, Ewing sarcoma, hemangiopericytoma, desmoplastic fibroma, neurofibrosarcoma, osteosarcoma, intimal sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, teratoma, and chordoma. A variety of tumors with musculoskeletal histology can arise in the abdomen and pelvis. In some cases, unique imaging characteristics allow a confident diagnosis, whereas other cases have a more nonspecific appearance. Recognition of imaging features that suggest a musculoskeletal tumor including direct extension from a bone or neural foramen, the presence of cartilaginous or osseous matrix, or macroscopic fat would allow the radiologist to suggest the proper diagnosis. Recognizing imaging characteristics of tumors with musculoskeletal histology is important clinically as management and prognosis differ from that of more common abdominal tumors.

Imaging Features of Primary and Metastatic Malignant Perivascular Epithelioid Cell Tumors

The objective of our study was to describe the imaging features of primary and metastatic malignant perivascular epithelioid cell tumors (PEComas). In this retrospective study, 36 patients (26 women, 10 men; mean age, 53.1 years; age range, 35-77 years) with a histopathologically confirmed diagnosis of malignant PEComa who were seen at our institute between January 2007 and December 2012 were included. Pretreatment imaging of the primary tumor in 17 patients (CT, n = 13; MRI, n = 9; ultrasound, n = 5) and follow-up imaging in all 36 patients (CT, n = 36; MRI, n = 7) were reviewed by three radiologists in consensus. The most common site of presentation of malignant PEComas was the retroperitoneum (38.9%) followed by the female genital tract (27.8%). Kidneys (8/36) and uterus (8/36) were the organs most frequently involved. The mean largest dimension was 11.01 cm (range, 4.5-25 cm). Primary tumors were well-circumscribed masses (16/17), were heteroechoic on ultrasound (5/5), were hypodense (2/6) to isodense (4/6) enhanced significantly (11/12) and compared with the paraspinal muscles on CT, were hypointense to isointense compared with skeletal muscle on T1-weighted imaging (8/9), were heterogeneously hyperintense compared with skeletal muscle on T2-weighted imaging (9/9), and showed significant post-gadolinium enhancement (7/7) on MRI. Of the 17 primary tumors, necrosis was seen in seven tumors, hemorrhage in three tumors, and calcification in three tumors. Twenty-six of 36 (72%) patients developed metastases, most commonly to the lung (21.6%), liver (17.6%), and peritoneum (10.8%). Malignant PEComas in our study were large tumors that most often arise in the kidneys and uterus and metastasize to lungs, liver, or peritoneum. In our experience malignant PEComas should be considered in the differential diagnosis of large well-circumscribed renal and uterine tumors.

Limbic Tumors of the Temporal Lobe: Radiologic–Pathologic Correlation

The purpose of this study was to assess imaging and pathologic characteristics of limbic tumors. Our hypothesis was that temporal lobe limbic tumors have distinctive features from extralimbic tumors. This retrospective radiologic-pathologic correlation study of primary temporal lobe tumors (excluding glioblastoma) distinguished limbic from extralimbic tumors based on preoperative magnetic resonance imaging. Limbic tumors were categorized according to Yaşargil's classification into (1) mediobasal temporal (mbT), (2) insular-temporo-opercular (I-TO), and (3) fronto-orbital-insular-temporopolar (FO-I-TP). A total of 50 cases with a mean age at diagnosis of 38 ± 19.9 years (14 women, 36 men) were included. Pathologic diagnoses were as follows: 20 anaplastic astrocytomas, 11 gangliogliomas, 8 astrocytomas (World Health Organization grade II), 3 pilocytic astrocytomas, 2 dysembryoplastic neuroepithelial tumors, 2 oligodendrogliomas (grade II), 2 anaplastic oligodendrogliomas, 1 low-grade glioneuronal tumor, and 1 atypical extraventricular neurocytoma. In all, 36 tumors were limbic and displayed consistent growth patterns (16 mbT, 11 I-TO, 8 FO-I-TP, and 1 pantemporal) and 14 were extralimbic. There were no differences between limbic and extralimbic tumors with regard to age, sex, pathologic diagnosis, and presentation with seizures. mbT tumors had more frequent neuronal differentiation (50 %) than I-TO (0 %) and FO-I-TP (25 %) tumors (chi-square = 7.8, df = 2, p = 0.02). Neuronal differentiation correlated with lower grade (r = 0.52, p < 0.01) and younger age (r = 0.52, p < 0.01). Limbic tumors displayed consistent growth routes. mbT limbic tumors had more frequent neuronal differentiation, which may result from proximity to the neurogenic subgranular zone of the hippocampus. Neuronal differentiation was maximal in mbT and lowest in I-TO and FO-I-TP tumors and correlated with lower tumor grade and younger age at diagnosis.

Comparative role of CT scan and MR imaging in primary malignant bone tumors

Aims: o To discuss the role of C.T. scan and M.R.I. in evaluation of primary malignant bone tumors. o To determine the imaging characteristics of different primary malignant bone tumors. o To correlate imaging with surgical and histological findings. Materials and methods: This prospective study of 13 cases was conducted in Shri M. P. Shah Medical College and G.G .Hospital, Jamnagar. Observations: A total of 13 patients with primary malignant bone tumors were evaluated primarily with plain radiography followed by C.T. scan and M.R.I .Contrast study was performed as and when deemed necessary. Following observations were made: There were 4 cases of Ewing’s sarcoma, 5 cases of osteosarcoma, a single case of each – bone lymphoma, malignant haemangioendothelioma, malignant giant cell tumor and chondrosarcoma. CT scan was better than MRI in evaluation of cortical destruction in 2 cases and both were equally efficient in 10 cases. Matrix mineralization was present in 5 cases and CT scan detected it with higher accuracy.MRI was better for evaluation of extent of bone marrow involvement in 5 cases and equal to CT scan in 5 cases. The soft tissue extent of tumor was better evaluated with MRI in 7 cases and both modalities were equally good in 6 cases. Joint involvement was present in 4 cases and was better evaluated with MRI in all of them.MRI was superior in evaluation of neurovascular bundle in 9 cases and equal to CT in 4 cases. Although MRI could demonstrate different components of tumor, there was no difference in signal intensity patterns of different histological types of tumors. Conclusions: MRI is the preferred modality to image musculoskeletal tumors and should be obtained after radiographic evaluation. Its multiplanar imaging capability helps delineation of tumor and its extent in bone and soft tissues with high contrast resolution. It is an excellent modality to determine neurovascular bundle

Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions.

BackgroundThe purpose of this study was to define the ultrasound imaging characteristics of adrenal tumors and to assess the performance of ultrasound in differentiating benign ‘leave-alone’ lesions from suspicious lesions.Material/MethodsWe enrolled 882 patients in this study. The nature of each lesion was determined by histopathology. Ultrasound finding of each lesion was compared with its corresponding histopathologic result. The final study group consisted of 911 adrenal masses in 882 patients. All images were reviewed by 2 experienced investigators in a double blind manner.ResultsThere were 553 adenomas identified in the study, which constituted 60.70% of the lesions. There were 161 pheochromocytomas (17.67%), 49 myelolipomas (5.38%), 39 cysts (4.28%), 37 metastasis (4.06%), 35 ganglioneuromas (3.84%), 22 lymphomas (2.41%), and 15 cortical carcinomas (1.65%). The sensitivity, specificity, and accuracy of ultrasound-based diagnosis were 89%, 99%, and 93.9%, respectively. A positive predictive value of 90.9% and a negative predictive value of 94.2% were obtained in this study.ConclusionsThis large-sample study showed that ultrasound was a reliable method in differentiating benign ‘leave-alone’ lesions from suspicious lesions.

CT findings of gallbladder metastases: emphasis on differences according to primary tumors.

ObjectiveTo describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors.Materials and MethodsTwenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined.ResultsThe most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out.ConclusionAlthough CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.

Features Suggestive of Gallbladder Malignancy

Gallbladder cancer carries an extremely high mortality rate, with a 5-year survival rate as low as 12%. Survival is dependent on the diagnosis of these tumors in their earliest stages. This study sought to describe the clinical and imaging features of stages T1, T2, and T3 gallbladder tumors and to illustrate features that may allow radiologists to make an early diagnosis. After approval from the institutional review board, a search of the pathology department database yielded 18 patients with surgically proven T1, T2, and T3 gallbladder cancers with available preoperative computed tomography (CT) or magnetic resonance imaging. The imaging was reviewed for lesional morphology (focal polyploid mass, focal wall thickening, circumferential wall thickening), enhancement characteristics, liver invasion, locoregional lymphadenopathy, and distant metastatic disease. The electronic medical record was also searched for demographic information and clinical presentation. There were 10 women and 8 men with a mean age of 69 years. Virtually all patients were symptomatic, with most patients demonstrating symptoms suggestive of underlying malignancy (including jaundice, weight loss, and chronic abdominal pain). Tumors on CT and MRI included 6 polyploid masses, 9 tumors with focal wall thickening, and 3 with circumferential wall thickening. The mean attenuation of those tumors imaged with CT was 59.4 Hounsfield units (HUs) on the arterial phase and 86.5 HUs on the venous phase, with a mean increase in Hounsfield attenuation between the arterial and venous phases of 28.2 HUs. Twelve of the 18 patients were correctly diagnosed prospectively on CT. The imaging findings of gallbladder cancer can be subtle, regardless of whether the tumor presents as a discrete mass, focal wall thickening, or circumferential diffuse wall thickening, and radiologists should be aware of the wide range of different possible appearances. Moreover, the vast majority of these patients had clinical symptoms suggestive of an underlying malignancy, and this should precipitate a careful evaluation of the gallbladder in all such cases.

Solitary fibrous tumors in abdomen and pelvis: imaging characteristics and radiologic-pathologic correlation.

To describe the imaging features of solitary fibrous tumors (SFTs) in the abdomen and pelvis, and the clinical and pathologic correlations. Fifteen patients with pathologically confirmed SFTs in the abdomen and pelvis were retrospectively studied with imaging techniques by two radiologists in consensus. Patients underwent unenhanced and contrast-enhanced imaging, as follows: 3 with computed tomography (CT) and magnetic resonance imaging (MRI) examination, 8 with CT examination only, and 4 with MRI examination only. Image characteristics such as size, shape, margin, attenuation or intensity, and pattern of enhancement were analyzed and correlated with the microscopic findings identified from surgical specimens. In addition, patient demographics, presentation, and outcomes were recorded. Of the 15 patients evaluated, local symptoms related to the mass were found in 11 cases at admission. The size of the mass ranged from 3.4 to 25.1 cm (mean, 11.5 cm). Nine cases were round or oval, 6 were lobulated, and 10 displaced adjacent organs. Unenhanced CT revealed a heterogeneous isodense mass in 7 cases, homogeneous isodense mass in 3 cases, and punctuated calcification in one case. On MRI, most of the lesions (6/7) were heterogeneous isointense and heterogeneous hyperintense on T1-weighted images and T2-weighted images, respectively. All tumors showed moderate to marked enhancement. Heterogeneous enhancement was revealed in 11 lesions, and 7 of these had cysts, necrosis, or hemorrhage. Early nonuniform enhancement with a radial area that proved to be a fibrous component was observed in 4 lesions, which showed progressive enhancement in the venous and delayed phase. No statistical difference in the imaging findings was observed between the histologically benign and malignant lesions. Three patients had local recurrence or metastasis at follow-up. Abdominal and pelvic SFTs commonly appeared as large, solid, well-defined, hypervascular masses with variable degrees of necrosis or cystic change that often displaced adjacent structures.

Magnetic Resonance Image Manifestations of the Atypical Meningioma

Through retrospective analysis of 13 cases of magnetic resonance image (MRI) manifestations of atypical meningiomas confirmed by operation and pathology in the First Affiliated Hospital of Xinxiang Medical University, the objective of this study was to evaluate the diagnostic value of MRI in order to improve the accuracy rate of preoperative diagnosis. In this retrospective analysis of MRI findings for atypical meningiomas in First Affiliated Hospital of Xinxiang Medical University from January to July in 2012, the location, morphology and tumor signals and other tumor imaging characteristics were covered. In 13 cases of atypical meningioma patients of this group, most tumors were located at typical sites (10/13), mainly the falx cerebri, parasagittal, convexity, saddle area. Only two cases were at atypical locations, 1 in the cerebellar hemisphere and 1 in a lateral ventricle. Most of the tumors showed T1 and T2 isointensity signals, and necrosis, calcification, and peritumoral edema were always featured. DWI showed isointensity in 11 cases (11/13), and hyperintensity in 2. Some 9 cases had dural tail signs, 12 had accurate positioning (12/13), and 2 were postoperative recurrences. MRI has high value in the diagnosis of atypical meningiomas, with important roles in early clinical diagnosis, treatment and prognosis evaluation.

Papillary neoplasms of the endolymphatic sac and mucosal lining of the pneumatic spaces of the temporal bone: Role of imaging

Primary adenomatous and adenocarcinomatous lesions of the temporal bone are rare tumors. Primary low-grade papillary adenocarcinomas of the endolymphatic sac origin were first reported by Heffner. These lesions, which are referred to as "Heffner tumors," are slow-growing, bone-destructive infiltrating tumors. Owing to the local bone destruction (usually centered at posterior petromastoid plate), the general consensus favors the endolymphatic sac as being the origin of these tumors. However, controversies regarding the cellular origins of adenomatous tumors of the temporal bone have been reported. Mafee and Shah reported a unique case in which histology was identical to papillary adenocarcinoma of endolymphatic sac in which the sac and duct showed normal findings on magnetic resonance images, which were confirmed on surgery. Computed tomography and magnetic resonance imaging are excellent imaging methods for evaluation of normal and anomaly of the vestibular aqueduct and endolymphatic duct and sac and for the diagnosis of these endolymphatic tumors. This article reviews computed tomography and magnetic resonance imaging characteristics of adenocarcinomatous tumors of temporal bone. This report also concerns a unique case of a papillary adenocarcinoma of presumed endolymphatic sac in a 12-year-old child, in which tumor replaced almost the entire petromastoid resulting in a markedly egg-shell appearance of the bone. To the best of our knowledge, this is the youngest child with papillary endolymphatic sac tumor reported.

Glomus tympanica and other intratympanic masses: Role of imaging

Tumors and tumorlike conditions in the temporal bone are numerous. Glomus tumors (nonchromaffin chemodectomas and paragangliomas) are the most common neoplasms of the middle ear and are second in frequency to only vestibular schwannomas within the temporal bone. Computed tomography and magnetic resonance imaging studies provide valuable information in determining the location and extension of middle ear glomus tumors as well as other potential mimics, such as facial nerve schwannoma, meningioma, extension of intralabyrinthine schwannoma into the middle ear, aberrant course of the internal carotid artery, exposed or high-riding jugular bulb, extramedullary hematopoiesis, adenoma, adenocarcinoma, papilloma, cholesterol granuloma, metastases, and tuberculous otitis media. This article reviews imaging characteristics of glomus complex tumors and selected potential mimics.

Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

AimTo determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). MethodsWe performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). ResultsMRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p<0.001), negative preoperative lymph node status (p=0.011), comparable tumor diameter at mammography and at ultrasound (p=0.001), negative HER2 status (p=0.044), and absence of invasive lobular cancer (p=0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. ConclusionsIt is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted.

Ovarian Sertoli–Leydig cell tumors: MRI findings and pathological correlation

BackgroundTo investigate the magnetic resonance imaging (MRI) characteristics of ovarian Sertoli-Leydig cell tumors (SLCT).MethodsThe clinical, MRI and pathological findings of five cases of SLCT were reviewed retrospectively. MRI appearances of tumors including laterality, shape and size, architecture, wall, septa and vegetation, signal intensity and contrast-enhancement pattern were evaluated and correlated with pathological findings.ResultsTwo tumors were solid which appeared as low signal intensity on T1-weighted imaging (T1WI) and moderate on T2-weighted imaging (T2WI) with multiple small cysts in one of them. The remaining three SLCT were multilocular cystic with the irregularly thickened wall and septa, and with solid area and mural nodules in one of them. The cystic components had the same signal intensity as urine. All the solid components were intensely enhanced after administration of contrast medium. All five tumors were pathologically intermediate differentiation and at FIGO stage I.ConclusionsSLCT demonstrate variable MRI morphological appearances. However, the irregularly thickened wall and septa, the moderate T2WI signal intensity and obvious enhancement in the solid components are three MRI features.

Clinical, pathological, and imaging characteristics of primitive neuroectodermal tumors of the spine

Primitive neuroectodermal tumors (PNETs) located in the spine are extremely rare, and information concerning these tumors in the medical literature is limited to single case reports. This pictorial essay presents the clinical, pathological, and imaging characteristics of PNET of the spine.

Imaging Features of Carcinoid Tumors of the Gastrointestinal Tract

Recent studies have provided a better understanding of the biologic behavior of gastrointestinal carcinoid tumors. This article focusing on imaging of gastrointestinal carcinoids will emphasize epidemiology, molecular biology, taxonomy, histopathology, and management. Gastrointestinal carcinoids are a biologically heterogeneous group of tumors, with variable clinical presentation and biologic behavior. Imaging can play an important role in multidisciplinary identification and management of this disease.

Tumors of the rib

The authors propose a pictorial review illustrating the imaging features of chest wall tumors and their specific features that discusses the main differential diagnoses. This review is based on published information and on our own experience.

Imaging findings of benign peripheral nerve sheath tumor in jaw

The aim of this study was to investigate the imaging characteristics of peripheral nerve sheath tumors (PNSTs) in the jaw. Imaging studies of 6 patients were retrospectively reviewed. Conventional radiography, computed tomography, and magnetic resonance imaging were performed in all patients. A fusiform lesion continuous with the nerve was observed in 2 cases, with the tumor arising within the inferior alveolar canal. In the other 4 cases, with the tumor arising outside the canal, the tumor had protruded and eroded into the bone. Protrusion was also present in 1 of the 2 cases, with the tumor arising within the canal. A target or fascicular sign was observed each in 1 case. A fusiform lesion continuous with the nerve and a target or fascicular sign was only present in a few cases. The PNSTs, however, showed a tendency to protrude into the bone.

Intrathoracic malignant peripheral nerve sheath tumors: imaging features and implications for management

BackgroundThe aim of the study was to analyze the clinical and imaging characteristics of primary intrathoracic malignant peripheral nerve sheath tumors (MPNSTs).Patients and methods.In this institutional review board (IRB)-approved retrospective study, clinical and imaging features of 15 patients (eight men; mean age 50 years [range 18–83)] with pathologically proven malignant peripheral nerve sheath tumors seen from January 1999 to December 2011 were analyzed. Imaging features (CT in 15, MRI in 5 and PET/CT in 4) of primary tumors were evaluated by three radiologists and correlated with clinical management.ResultsOf the 15 tumors, six were located in the mediastinum (two each in anterior, middle and posterior mediastinum), four in chest wall, two were paraspinal, and three in the lung. Four patients had neurofibromatosis-1 (NF1); four tumors had heterologous rhabdomyoblastic differentiation (malignant triton tumor). Masses typically were elongated along the direction of nerves, with mean size of 11 cm. The masses were hypo- or isodense to muscles on CT, isointense on T1-weighted images, hyperintense on T2-weighted images and intensely fluorodeoxyglucose (FDG) avid (mean standardized uptake value [SUV]max of 10.5 [range 4.4–23.6]). Necrosis and calcification was seen in four tumors each. Finding of invasion of adjacent structures on imaging led to change in management in seven patients; patients with invasion received chemoradiation.ConclusionsIntrathoracic MPNSTs appear as large elongated masses involving mediastinum, lung or chest wall. Radiological identification of invasion of adjacent structures is crucial and alters therapy, with patients with invasion receiving neoadjuvant or adjuvant chemoradiation.

Detectability and clinicohistological characteristics of small (≤1 cm) invasive breast cancer

PurposeTo investigate the detectability and imaging characteristics of primary tumors according to imaging modalities and to identify clinical features and histological prognostic factors for axillary metastases in patients with small (≤1cm, T1a and T1b) invasive breast cancer. Materials and methodsA total of 221 patients with histologically confirmed small invasive cancers were included for the statistical analysis. At mammography, ultrasonography and MRI, the detectability, and imaging characteristics of primary tumors were compared in patients with or without axillary metastases. Clinical features and histological prognostic factors for axillary metastases were investigated. ResultsOf 221 patients examined, axillary metastasis was found in 42 (19%) at the time of surgery. There was no significant difference in detectability of small tumors using ultrasonography and MRI between patients with and without axillary metastasis. However, mammography had a higher positive rate of primary tumors in patients with axillary metastasis than without metastasis (92.9% vs. 77.1%, p=0.023). Patients with axillary metastasis in small cancers showed more common architectural distortion than negative (p=0.0147) or mass (p=0.0356) on mammography. Clinical features were not different in the two groups. Only lymphovascular invasion was independently associated with axillary metastasis (p=0.0051, 95% CI, 1.527–11.597). ConclusionThe detectability of small invasive breast cancers among patients with and without axillary metastasis is different with mammography, but not with US and MRI. Lymphovascular invasion is only a predictor for axillary metastasis in small invasive cancers.

Imaging features of pancreatic tumors in children: 13-year experience at a pediatric tertiary hospital

Pancreatic tumors are rare in children, resulting in limited information regarding their frequency and imaging appearances. To review all pancreatic tumors seen in children over a decade at a large tertiary pediatric institution and to describe multimodality imaging findings. We conducted a retrospective review of imaging studies performed in children with pancreatic tumors between January 2000 and December 2012, analyzing imaging features on available US, CT and MR examinations. We reviewed patient charts for clinical features, management and final diagnosis. We included 23 children in this study. Of these, 12 had solid and papillary epithelial neoplasms (SPEN), 3 had neuroendocrine tumors, 3 had lymphoma, and 1 each had hemangioendothelioma, benign congenital cysts with adipose tissue, dendritic cell sarcoma, metastatic rhabdomyosarcoma, and lipoma. All children with SPEN were teenage girls. SPEN showed characteristic imaging features including well-defined margins with surrounding capsule, solid-cystic components and hemorrhage. Pancreatic tumors are uncommon in children. SPEN is the most common tumor and is seen predominantly in teenage girls and shows characteristic imaging features.