title: Pancreatic involvement in neuroblastoma with radiologic-pathologic correlation: a single-institution experience.
abstract: OBJECTIVE
  Pancreatic involvement in neuroblastoma is extremely rare, with few cases reported in the literature. We present imaging findings of pancreatic involvement in neuroblastoma with clinical and pathologic correlation in the largest documented series to date.
  
  
  METHODS
  We prospectively reported pancreatic involvement evident on multimodality imaging in neuroblastoma patients presenting to our institution from 1997 to 2011. Lesions were classified according to location within the pancreas, and imaging features were correlated with cytogenetic and surgicopathologic findings.
  
  
  RESULTS
  Neuroblastoma involving the pancreas was evident on imaging of seven of 1031 patients (mean age, 6.6 years). One patient had pancreatic involvement at presentation, and six developed pancreatic disease at relapse or disease progression. Pancreatic lesions were most frequently initially identified on concurrent CT and (123)I-metaiodobenzylguanidine scintigraphy, and additional lesions initially were found on MRI and ultrasound. Five of seven patients had focal lesions, one had diffuse pancreatic involvement, and one had pancreatic extension from contiguous disease. The distribution of lesions favored the pancreatic body and tail. All patients had International Neuroblastoma Staging System stage 3 or 4 disease, Children's Oncology Group intermediate- or high-risk disease, and unfavorable histology at initial diagnosis. For the five patients with surgical correlation, pancreatic surgical specimens revealed neuroblastoma in three cases and ganglioneuroblastoma in two cases.
  
  
  CONCLUSIONS
  Although rare, pancreatic involvement in neuroblastoma occurs. Its variable imaging appearance should be considered when evaluating the retroperitoneum in patients with known or suspected neuroblastoma, particularly because increased patient survival holds the potential for uncommon patterns of recurrence.
authors.affiliation: Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065, USA. dgr2001@nyp.org
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Rosenbaum
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Abramson
authors.forename: Eithne
authors.initials: E
authors.lastname: DeLappe
authors.forename: Julie
authors.initials: J
authors.lastname: Teruya-Feldstein
authors.forename: Michael P
authors.initials: MP
authors.lastname: La Quaglia
authors.forename: Josef J
authors.initials: JJ
authors.lastname: Fox
authors.forename: Anita P
authors.initials: AP
authors.lastname: Price
mesh_terms: D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000175:diagnosis* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D019275:Radiopharmaceuticals
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals