Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation

Schima, Wolfgang; Böhm, G.; Rösch, Christiane Sophie; Alexander, Klaus; Függer, R.; Kopf, H

doi:10.1186/s40644-020-00324-z

Cited by 54 publications

(47 citation statements)

References 48 publications

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“…The presence of (pseudo)cysts and parenchymal or intraductal calcifications may suggest an inflammatory cause, although these findings can also sometimes be found in intraductal papillary mucinous neoplasms, especially with main duct involvement[ 39 , 42 ]. Peripheral displacement of calcifications can be seen in patients with a malignant mass in the background of CP[ 43 ]. Another imaging feature that can be used to differentiate between malignancy and inflammation is the extent of ductal dilation and parenchymal atrophy, expressed by the pancreatic duct-to-parenchyma ratio.…”

Section: Diagnostics: Pancreatitis or Pancreatic Cancer?mentioning

confidence: 99%

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

Umans¹,

Hoogenboom²,

Sissingh³

et al. 2021

WJG

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Acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer are three distinct pancreatic diseases with different prognoses and treatment options. However, it may be difficult to differentiate between benign and malignant disease. AP may be a first symptom of pancreatic cancer, particularly in patients between the ages of 56 and 75 with presumed idiopathic AP who had a concomitant diagnosis of new-onset diabetes mellitus or patients who present with CP at diagnosis of AP. In these patients, additional imaging is warranted, preferably by endoscopic ultrasonography. CP may lead to pancreatic cancer through oncogenic mutations, mostly in patients with hereditary CP, and in patients in whom risk factors for pancreatic cancer ( e.g. , nicotine and alcohol abuse) are also present. Patients with PRSS1 -mediated CP and patients with a history of autosomal dominant hereditary CP without known genetic mutations may be considered for surveillance for pancreatic cancer. Pancreatic inflammation may mimic pancreatic cancer by appearing as a focal mass-forming lesion on imaging. Differentiation between the above mentioned benign and malignant disease may be facilitated by specific features like the duct-penetrating sign and the duct-to-parenchyma ratio. Research efforts are aimed towards developing a superior discriminant between pancreatitis and pancreatic cancer in the form of imaging modalities or biomarkers. This may aid clinicians in timely diagnosing pancreatic cancer in a potentially curable stage.

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Section: Diagnostics: Pancreatitis or Pancreatic Cancer?mentioning

confidence: 99%

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

Umans¹,

Hoogenboom²,

Sissingh³

et al. 2021

WJG

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“…Histologisch [6]. Zusätzlich liefert die Messung des "standard uptake value" (SUV) ebenso Hinweise zur Differenzialdiagnose, da die fokale AIP geringere SUV-Werte als das Pankreaskarzinom aufweist [23].…”

Section: Autoimmunpankreatitisunclassified

“…Eine Verlagerung bzw. Verdrängung der parenchymalen Verkalkungen in Zusammenhang mit einer neu aufgetretenen fokalen Weichteilmasse bei einer diffus verkalkten CP sollte den Verdacht auf ein Pankreaskarzinom bei CP erhärten [23].…”

Section: Introductionunclassified

Chronische Pankreatitis

et al. 2021

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Zusammenfassung Klinisches/methodisches Problem Bei der chronischen Pankreatitis (CP) handelt es sich um eine langanhaltende Entzündung der Bauchspeicheldrüse, welche die normale Struktur und Funktion des Organs schädigt. Das breite Spektrum an entzündlichen Pankreaserkrankungen umfasst einzelne Entitäten, wie die fokale Pankreatitis (FP) oder den Pseudotumor („mass-forming pancreatitis“), welche radiomorphologisch ein Adenokarzinom der Bauchspeicheldrüse (PDAC) nachahmen können. In weiterer Folge kann eine Fehldiagnose zu einem vermeidbaren und unnötigen operativen Eingriff oder zu einer Therapieverzögerung führen. Radiologische Standardverfahren Der Ultraschall (US) ist das primäre bildgebende Verfahren zur Abklärung von Pankreaserkrankungen, gefolgt von kontrastmittelverstärkter Computertomographie (KM-CT), die als meistverwendete Methode bei der diagnostischen Abklärung von Bauchspeicheldrüsenerkrankungen gilt. Die Magnetresonanztomographie (MRT) und/oder die MR-Cholangiopankreatographie (MRCP) können als Problemlöser eingesetzt werden, um zwischen soliden und zystischen Läsionen zu unterscheiden sowie auch Anomalien der Pankreasgänge auszuschließen, welche bei rezidivierender akuter Pankreatitis (AP) vorhanden sein können, oder um frühe Anzeichen einer CP zu visualisieren. Die MRCP hat dabei die diagnostische endoskopische retrograde Cholangiopankreatographie (ERCP) in der Abklärung von therapeutischen Interventionen im Wesentlichen ersetzt. Empfehlung für die Praxis Folgender Übersichtsartikel fasst die relevanten Merkmale in der Computertomographie (CT) und MRT zusammen, um eine akkurate, frühzeitige Diagnose einer CP zu stellen und eine Differenzierung zwischen FP und Pankreaskarzinom zu ermöglichen, um somit – auch in schwierigen Fällen – ein adäquates Therapiemanagement zu gewährleisten.

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“…A variety of benign pancreatic lesions may grossly appear intra-operatively as well-demarcated zone of parenchymal fibrosis and retention cysts as a result of chronic pancreatitis. Other benign lesions include inflammatory masses and pseudotumors, lymphoepithelial and epidermoid cysts and pancreatic hamartomas, hemangiomas and lymphangiomas (5)(6)(7)(8) . These benign diseases may be designated as pancreatic tumor-like lesions or pseudotumors (6,8,9) .…”

Section: Introductionmentioning

confidence: 99%

Enucleation Versus Standard Pancreatic Resection for Benign Lesions and Borderline Tumors: A Comparative Study

El‐Badry¹,

Mahmoud²,

Ali³

2022

The Egyptian Journal of Hospital Medicine

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Background: Enucleation of pancreatic benign lesions and borderline tumors, compared with standard pancreatic resection, may avoid postoperative impairment of the metabolic pancreatic functions. However, its influence on postoperative morbidity and disease recurrence seems obscure. Therefore, the choice between both approaches remains controversial.Objective: To evaluate the outcome of enucleation compared with standard pancreatic resection (SPR) of pancreatic benign lesions and borderline tumors among patients presented to Sohag University Hospital. Patients and Methods: Adult patients who underwent enucleation (group A) versus standard resections (group B) of pancreatic benign lesions and borderline tumors at Sohag University Hospital (June 2017 -May 2021) were prospectively enrolled. Both surgical techniques were compared regarding their influence on postoperative metabolic functions of the pancreas, surgical complications, and disease recurrence. Results: Sixteen patients (eight per group) with comparable gender and age distribution were eligible. Group A had significantly shorter operative time, lower amounts of intra-operative blood loss and less transfusions compared to group B. Likewise, patients in group A exhibited significantly reduced severity of surgical complications, including postoperative pancreatic fistula, and required significantly shorter periods of hospital stay. The incidence of new onset diabetes mellitus and pancreatic exocrine insuffficiency were significantly lower among patients in group A compared with those in group B. During follow-up, no recurrence was found in both groups. Conclusion: It could be concluded that enucleation of pancreatic benign lesions and borderline tumors preserves pancreatic metabolic functions, reduces postoperative morbidity and confers satisfactory oncologic outcome.

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Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation

Cited by 54 publications

References 48 publications

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

Chronische Pankreatitis

Enucleation Versus Standard Pancreatic Resection for Benign Lesions and Borderline Tumors: A Comparative Study

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