Cavernous hemangioma of adult pancreas: A case report and literature review

Table 2 Differential diagnoses of cystic and cystic-solid lesions of pancreas

Cystic lesions	Sex/age/size/site	Imaging, cytology features
Pseudocysts	Any	Unilocular
Serous cystic neoplasms	F/60s/large/body or tail	Serous and mucinous cystadenoma similar on CT
		Central fibrous scar with calcification
		Septation
		Multiple cysts lined by glycogen-rich epithelial cells that are positive for periodic acid Schiff and express cytokeratins
Mucinous cystic neoplasms	F/50-60s/> 10 cm/body or tail	Single multilocular cysts that do not communicate with the ductal system
		Smooth shape, even wall, with or without (fine) septa with potential small nodules
		Peripheral egg shell calcification
		Cyst lined by columnar mucin-producing epithelial cells set within an ovarian-like stroma
		Dysplasia and malignant potential
		Express keratin, carcinoembryonic antigen and CA19-9, while CK20 and CDX2 (markers of intestinal differentiation) are negative
IPMN	M = F/70-80s/head	Intraductal proliferation of mucinous cells usually showing papillary projections
		Dysplasia, invasion and malignant potential
		The epithelium of IPMNs expresses keratins, CEA and CA19-9, with variable expression of MUC
Solid pseudopapillary neoplasms	Young F/> 10 cm/tail, head	Solid or cystic-solid hypervascular tumors, solid part enhances
		Show pseudopapillae and pseudocysts
		Stain for vimentin and beta catenin with partial reactivity to keratin
		CD56 and synaptophysin stains may be positive, chromogranin negative
Cystic change of solid tumors	PDAC is rare < 50, M = F	Recognition of adjacent solid lesion (carcinoma) is the key to correct diagnosis of ductal adenocarcinoma
		PDAC are fibrotic, hypo-vascular, ill defined border, early infiltration in peri-pancreatic fat, invasion of vascular structures and ducts
		NET and Islet cell tumors are hyper-vascular and hyper-enhancing with positive staining for chromogranin and synaptophysin
Lymphoepithelial cysts	M/50-60s/ body or tail	Lined by squamous epithelium and surrounded by dense lymphoid tissue, possibly showing germinal centers
Vascular tumors (Lymphangiomas, hemangiomas, hemolymphangioma, hemangioendothelioma, angiosarcoma	F > M/large	Cystic-solid, encapsulated, multi-loculated, micro-cystic portions appear solid and enhancing
		Vascular markers CD31, CD34 and factor VIII are positive in endothelial cells
		Cytokeratins neg
		Lymphatic marker D2-40 neg in hemangioma, positive in lymphangioma
		Angiosarcomas, highly aggressive, a vascular channel lined by variably atypical endothelial cells
Metastatic from renal cell cancer		Hypervascular, invasive
Accessory splenic tissue	Tail	hypervascular
Others		Rare solid tumors of the pancreas also include: mature teratoma, hamartoma, sarcoidosis, yolk sac tumor, acinar cell carcinoma, lymphoplasmatic sclerosing pancreatitis, primary pancreatic lymphoma., duodenal tumor, duplication cysts, paraganglioma, cystic GIST, glomus tumor, etc.

IPMN: Intraductal papillary mucinous neoplasms; PDAC: Pancreatic ductal adenocarcinoma.