Pancreatic Tumors
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
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Case-Based Learning
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Pancreatic Masses
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Drs Jaimie Nathan, Rae Hanke, Alex Gibbons, and Todd Ponsky discuss diagnosis and management of pancreatic masses Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes
podcast · 37:28 · Dec 2020
In-Depth Reviews
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Pancreatic Tumors. Presented by David Skarda, MD 04.10.23 Video
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Dr. Skarda reviews classification and management of pediatric pancreatic tumors, focusing on benign cystic lesions including serous and mucinous cystadenomas and mature cystic teratomas. Discussion covers imaging characteristics, malignant
video · 50:30 · Apr 2023
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Every statement below comes from the recorded discussions, with its speaker and moment.
Pancreatic Tumors. Presented by David Skarda, MD 04.10.23 Video
Serous cystadenomas are benign lesions that may grow and become symptomatic, with rare case reports of malignant transformation, and about one-third are identified incidentally
clinicalDavid Skarda2:44 ↗
Serous cystadenomas are cured by removal
clinicalDavid Skarda3:27 ↗
Mucinous cystadenomas are more common in females and the majority are located in the tail of the pancreas
epidemiologicalDavid Skarda3:54 ↗
Mucinous cystadenomas are generally considered benign but potentially pre-malignant lesions
clinicalDavid Skarda4:17 ↗
Mature cystic teratomas can arise anywhere within the pancreatic parenchyma and are often adjacent to the pancreas in the retroperitoneum
clinicalDavid Skarda4:51 ↗
Mature cystic teratomas can contain malignancy and are resected based on symptoms and malignant potential
clinicalDavid Skarda5:21 ↗
Solid pseudopapillary tumors are the most common malignant pancreatic tumor in young children, with mean age of 5 years and twice as common in males
epidemiologicalDavid Skarda25:55 ↗
Pancreatoblastoma is associated with Beckwith-Wiedemann syndrome and FAP, with some tumors having genetic abnormalities on chromosome 11p15
clinicalDavid Skarda26:10 ↗
In pancreatoblastoma, alpha-fetoprotein is elevated in a fairly high percentage of cases and can be used to monitor for recurrence after resection
clinicalDavid Skarda26:58 ↗
About 60% of gastrinomas are not in the pancreas but in the wall of the duodenum, typically between the common bile duct insertion and the junction of the 2nd and 3rd portion of duodenum
clinicalDavid Skarda47:12 ↗
Solid pseudopapillary tumors occur in young women more than young men, with mean age of diagnosis 28 years
epidemiologicalDavid Skarda18:21 ↗
Complete surgical resection with clear margins is the treatment of choice for solid pseudopapillary tumors, and enucleation is not considered adequate treatment
guidelineDavid Skarda18:32 ↗
Overall survival for solid pseudopapillary tumors is really good with complete resection, and lymph node metastases are fairly rare
clinicalDavid Skarda19:08 ↗
Solid pseudopapillary tumors can present with metastatic disease in 15-20% of cases, but survival is still quite good without adjuvant therapy after resecting the primary tumor
clinicalDavid Skarda20:44 ↗
Mucinous cystadenocarcinomas can be challenging to differentiate from mucinous cystadenomas and frequently have foci of dysplastic or frankly malignant epithelium, making sampling problematic
clinicalDavid Skarda31:20 ↗
Acinar cell adenocarcinomas in young children (around 3 years old) tend to be well-circumscribed masses, occur more commonly in males, and can be equally distributed throughout the pancreas
clinicalDavid Skarda32:48 ↗
Acinar cell adenocarcinomas have much better prognosis than typical ductal adenocarcinoma, and adjuvant chemotherapy or radiation is not necessary after complete resection
clinicalDavid Skarda33:22 ↗
Pancreatic ductal adenocarcinomas in young people are often associated with FAP, Peutz-Jeghers syndrome, or hereditary pancreatic cancer syndrome
clinicalDavid Skarda34:02 ↗
Insulinomas are the most common pancreatic neuroendocrine tumor and are beta islet cell neoplasms that produce excessive insulin leading to hypoglycemia
clinicalDavid Skarda36:12 ↗
Insulinomas tend to be small, relatively well encapsulated, and diagnosed fairly early because they produce insulin
clinicalDavid Skarda36:33 ↗
Whipple's triad for insulinoma diagnosis includes signs and symptoms of hypoglycemia, documented hypoglycemia during the symptomatic period, and resolution of symptoms with glucose administration
guidelineDavid Skarda36:43 ↗
C-peptide levels are checked to ensure hypoglycemia is not from exogenous insulin administration
clinicalDavid Skarda38:57 ↗
Insulinomas tend to be relatively well encapsulated and surprisingly do not have blood vessels attached to them despite being endocrine tumors
clinicalDavid Skarda40:46 ↗
Sporadic insulinomas in children are often isolated and benign, while those with MEN1 tend to be multifocal and have higher incidence of malignancy
clinicalDavid Skarda45:24 ↗
80% of gastrinomas occur sporadically, but 20% occur in the setting of MEN1, with MEN1-associated lesions tending to be multicentric, malignant, and presenting at higher rates of metastasis
epidemiologicalDavid Skarda46:38 ↗
Endoscopic ultrasound is really good at finding insulinomas and helps identify the relationship of the mass to the pancreatic duct
clinicalDavid Skarda41:52 ↗
For incidental pancreatic cystic lesions less than 2 centimeters that are difficult to access with biopsy, observation with surveillance imaging is reasonable if they remain stable
opinion10:58 ↗
In adults, serous cystadenomas do not require surveillance imaging once diagnosed
guideline14:34 ↗
Insulinoma enucleation involves popping the tumor out like a grape, with the main concern being the relationship of the tumor to the pancreatic duct
clinical41:09 ↗
Pancreatic Masses
Pancreatoblastoma is the most common malignant pancreatic tumor in children, typically presenting in patients less than 10 years of age
clinicalJamie Nathan5:14 ↗