A 70-year-old man presents with abdominal pain and weight loss in the last few months.

Fig. 35.1 (A) An axial contrast-enhanced CT image of the abdomen demonstrates a large, encapsulated, rounded mass localized in the head and neck of the pancreas. The mass is extremely heterogeneous, as it contains both areas of fluid and soft tissue attenuation; a thin capsule is observed and presents mild enhancement as well as the peripheral solid intratumoral components. The pancreatic parenchyma is otherwise unremarkable, and no sign of pancreatic duct dilatation is documented. (B) Axial image through the liver in the same patient shows a well-demarcated lesion in the left hepatic lobe of the liver with attenuation characteristics similar to the primary pancreatic lesion. This was found to represent a solitary metastasis on surgical biopsy.

Solid papillary epithelial neoplasm (SPEN)

• Pancreatic cystic neoplasms: serous cystoadenoma, mucinous cystic neoplasms
  
• Rare pancreatic cystic neoplasms: acinar cell cystoadenocarcinoma, hemangioma, paraganglioma
  
• Solid pancreatic lesion with cystic degeneration: pancreatic adenocarcinoma, nonfunctioning cystic islet cell tumor (insulinoma, glucagonoma, gastrinoma)
  
• Calcified hemorrhagic pseudocyst
  
• Pancreatoblastoma
  
• Metastases