Primary pancreatic carcinoma and pancreatic metastases are rare in the pediatric population. Pancreatoblastoma is the most common pancreatic malignant tumor in young children and solid-pseudopapillary tumor in teenagers

Pancreatic adenocarcinoma is extremely rare under the age of 40 and is usually associated with underlying genetic abnormalities. Secondary malignancies of the pancreas occur more frequently than primary pancreatic malignancies in children and are most commonly seen with non-Hodgkin lymphomas (NHL) and mesenchymal sarcomas.

A retrospective analysis of all primary and secondary pancreatic malignancies imaged with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) computed tomography (CT) was conducted.

Three patients with primary pancreatic cancers were identified, one each with pancreatoblastoma, solid-pseudopapillary tumor, and adenocarcinoma. Each tumor showed elevated uptake of FDG.

Metastatic disease

Metastatic disease in the pancreas was identified in 12 patients-five NHL, six sarcomas, and one malignant rhabdoid tumor. Elevated but variable uptake of FDG was found in each of the tumors of patients with metastatic disease within the pancreas.

Pancreatic tumors are rare in children. In the series, they described three patients with primary pancreatic malignancies and 12 with secondary pancreatic involvement.

Comprising approximately 0.2% of pancreatic tumors, pancreatoblastomas tend to occur in children 1–8 years of age and are extremely rare in adults. They occur more frequently in individuals with Beckwith–Weideman syndrome.

Pancreatoblastomas tend to arise in the pancreatic body or tail and average about 1.5– 2.0 cm diameter at diagnosis. On imaging, pancreatoblastomas have a round or lobulated appearance and are typically encapsulated. Necrosis and cystic changes are often present, and the tumors typically compress adjacent structures without invasion.3,16 Prognosis is poor if these lesions are not completely resected.

In conclusion, both primary pancreatic tumors and pancreatic metastases are well characterized metabolically using FDG–PET CT. Unlike the findings in adults, in our series, a secondary involvement of the pancreas was more common than a primary pancreatic tumor. No characteristic pattern of uptake or distribution was evident in the three patients with primary pancreatic malignancies.

Of the patients with a primary pancreatic disease, only the patient with SPT, who had localized, surgically resectable disease survived. A diffuse pattern of uptake was found in four of the five patients with lymphoma but in none of the other patients with pancreatic tumors.

Patients with secondary lymphoma of the pancreas generally had favorable responses to treatment, whereas patients with secondary sarcomas died of disease.