Historically known as islet cell or carcinoid tumors

Variable: Range from < 1 cm to > 20 cm; typically 1-5 cm

Small tumors: Well-defined, round, hypoechoic; can be isoechoic with focal contour deformity

Larger tumors are well demarcated, lobulated, and more heterogeneous with cystic change/necrosis and calcification

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  Displaces, rather than invades, adjacent structures

  
  
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  Intratumoral calcification suggests malignancy

  
  
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  60-90% have adenopathy and liver metastases at clinical presentation

Absence of pancreatic ductal dilation

Color Doppler: Intratumoral flow

Mucinous cystic pancreatic neoplasm

Solid pseudopapillary neoplasm

Pancreatic ductal carcinoma

Pancreatic metastases or lymphoma

Serous cystadenoma of pancreas

All pETs have malignant potential

↑ serum chromogranin A is 70% sensitive for pancreatic endocrine tumors

2-3% of all pancreatic neoplasms; peak: 4th-6th decades; younger in familial cases; most occurring sporadically

Familial syndromes: Multiple endocrine neoplasia type I; von Hippel-Lindau, neurofibromatosis type 1, tuberous sclerosis

Functioning tumors: Smaller at time of presentation due to hormonal production of insulin, glucagon, and gastrin

Nonfunctional tumors (60-80%): Usually asymptomatic but larger size at time of diagnosis; may cause mass effect and abdominal pain from primary or metastases

Prognosis: Best for insulinomas (most common functional)

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  50-80% noninsulinomas recur or metastasize

Poor prognostic features: Size > 2-4 cm; cystic change, calcification, necrosis

Surgical resection is only curative treatment for pancreatic endocrine tumors

Insulinoma (Whipple triad): Recurrent symptomatic hyperglycemia

Gastrinoma (Zollinger-Ellison syndrome): Peptic ulcer, esophagitis, and diarrhea

Glucagonoma (4D syndrome): D ermatitis, d iabetes, D VT, and d epression

Differentiate from other solid, cystic, hypervascular tumors

Correlate with clinical and biochemical information