Pancreas

The most likely diagnosis in the 60-year-old with an incidental masses,

while I see a vascular lesion in the head of the pancreas,

was washes out on the venous phase imaging.

I have to admit, I don't think too much about this case

before I say it's a neuroendocrine tumor.

It could be metastatic renal cell,

but the kidneys look okay here.

It's surely not pancreatic adenocarcinoma,

which are hypovascular lesions.

But it also could be a psiracist adenoma.

Why do I say that?

Because there's a type of psiracist adenomas

that are very, very vascular

and look identical to neuroendocrine tumors.

They wash out, and it's a real challenge.

And this ended up being biopsyde

and indeed was a solid psiracist adenoma.

You can see the marked vascularity.

I have to admit, there's no way you could say

this wasn't a neuroendocrine tumor

and statistically probably is more likely

a neuroendocrine tumor,

but this was a psiracist adenoma.

So I'm giving credit for A and B,

but remember to think about psiracist adenomas.

Again, EOS with biopsy, looking at fluid

with a psiracist adenoma, VHL markers are positive.