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Published in: Abdominal Radiology 2/2018

01-02-2018

Imaging mimics of pancreatic ductal adenocarcinoma

Authors: Namita S. Gandhi, Myra K. Feldman, Ott Le, Gareth Morris-Stiff

Published in: Abdominal Radiology | Issue 2/2018

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Abstract

Pancreatic ductal adenocarcinoma is the most common primary malignancy of the pancreas. The classic imaging features are a hypovascular mass with proximal ductal dilatation. Different pancreatic pathologies can mimic the imaging appearance of carcinoma including other tumors involving the pancreas (pancreatic neuroendocrine tumors, lymphoma, metastasis, and rare tumors like pancreatic acinar cell carcinoma and solid pseudopapillary tumors), inflammatory processes (chronic pancreatitis and autoimmune pancreatitis), and anatomic variants (annular pancreas). Differentiation between these entities can sometimes be challenging due to overlap of imaging features. The purpose of this article is to describe the common entities that can mimic pancreatic cancer on imaging with illustrative examples and to suggest features that can help in differentiation of these entities.
Literature
1.
go back to reference De Juan C, Sanchez M, Miquel R, et al. (2008) Uncommon tumors and pseudotumoral lesions of the pancreas. Curr Probl Diagn Radiol 37(145):164 De Juan C, Sanchez M, Miquel R, et al. (2008) Uncommon tumors and pseudotumoral lesions of the pancreas. Curr Probl Diagn Radiol 37(145):164
2.
go back to reference Feldman MK, Gandhi NS (2016) Imaging evaluation of pancreatic cancer. Surg Clin N Am 96:1235–1256CrossRefPubMed Feldman MK, Gandhi NS (2016) Imaging evaluation of pancreatic cancer. Surg Clin N Am 96:1235–1256CrossRefPubMed
3.
4.
go back to reference Gerritsen A, Molenaar QI, Bollen T (2014) Preoperative characteristics of patients with presumed pancreatic cancer but ultimately benign disease: a multicenter series of 344 pancreatoduodenectomies. Ann Surg Oncol 21:3999–4006CrossRefPubMed Gerritsen A, Molenaar QI, Bollen T (2014) Preoperative characteristics of patients with presumed pancreatic cancer but ultimately benign disease: a multicenter series of 344 pancreatoduodenectomies. Ann Surg Oncol 21:3999–4006CrossRefPubMed
5.
go back to reference Manzia TM, Toti L, Lenci I, et al. (2010) Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration. Ann R Coll Surg Engl 92(4):295–301CrossRefPubMedPubMedCentral Manzia TM, Toti L, Lenci I, et al. (2010) Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration. Ann R Coll Surg Engl 92(4):295–301CrossRefPubMedPubMedCentral
6.
go back to reference National comprehensive cancer network clinical practice guidelines in oncology: neuroendocrine tumors version 3.2017-June 13, 2017 National comprehensive cancer network clinical practice guidelines in oncology: neuroendocrine tumors version 3.2017-June 13, 2017
7.
go back to reference Sheth S, Hruban RK, Fishman EK (2002) Helical CT of islet cell tumors of the pancreas: typical and atypical manifestations. Am J Rontegenol 179:721–730 Sheth S, Hruban RK, Fishman EK (2002) Helical CT of islet cell tumors of the pancreas: typical and atypical manifestations. Am J Rontegenol 179:721–730
8.
go back to reference Lewis RB, Lattin GE Jr, E Paal (2010) Pancreatic endocrine tumors: radiologic-clinical pathologic correlation. RadioGraphics 30(6):1445–1464CrossRefPubMed Lewis RB, Lattin GE Jr, E Paal (2010) Pancreatic endocrine tumors: radiologic-clinical pathologic correlation. RadioGraphics 30(6):1445–1464CrossRefPubMed
9.
go back to reference Jeon SK, Lee JM, Joo I, et al. (2017) Nonhypervascular pancreatic neuroendocrine tumors: differential diagnosis from pancreatic ductal adenocarcinomas at mr imaging—retrospective cross-sectional study. Radiology 284(1):77–87CrossRefPubMed Jeon SK, Lee JM, Joo I, et al. (2017) Nonhypervascular pancreatic neuroendocrine tumors: differential diagnosis from pancreatic ductal adenocarcinomas at mr imaging—retrospective cross-sectional study. Radiology 284(1):77–87CrossRefPubMed
10.
go back to reference Kim JH, Eun HW, Kim YJ, et al. (2016) Pancreatic neuroendocrine tumor (PNET): staging accuracy of MDCT and its diagnostic performance for the differentiation of PNET with uncommon CT findings from pancreatic adenocarcinoma. Eur Radiol 26:1338–1347CrossRefPubMed Kim JH, Eun HW, Kim YJ, et al. (2016) Pancreatic neuroendocrine tumor (PNET): staging accuracy of MDCT and its diagnostic performance for the differentiation of PNET with uncommon CT findings from pancreatic adenocarcinoma. Eur Radiol 26:1338–1347CrossRefPubMed
11.
go back to reference Tsitouridis I, Diamantopoulou A, Michaelides M, et al. (2010) Pancreatic metastases: CT and MRI findings. Diagnos Interv Radiol 16(1):45–51 Tsitouridis I, Diamantopoulou A, Michaelides M, et al. (2010) Pancreatic metastases: CT and MRI findings. Diagnos Interv Radiol 16(1):45–51
12.
go back to reference Scatarige JC, Horton KM, Sheth S, et al. (2001) Pancreatic parenchymal metastases observations on helical CT. Am J Roentgenol 176(3):695–699CrossRef Scatarige JC, Horton KM, Sheth S, et al. (2001) Pancreatic parenchymal metastases observations on helical CT. Am J Roentgenol 176(3):695–699CrossRef
13.
go back to reference Ahmed S, Johnson PT, Hruban R, et al. (2013) Metastatic disease to the pancreas: pathologic spectrum and CT patterns. Abdom Imaging 38:144–153CrossRefPubMed Ahmed S, Johnson PT, Hruban R, et al. (2013) Metastatic disease to the pancreas: pathologic spectrum and CT patterns. Abdom Imaging 38:144–153CrossRefPubMed
14.
go back to reference Dawson IM, Cornes JS, Morson BC (1961) Primary malignant lymphoid tumors of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg 49:80–89CrossRefPubMed Dawson IM, Cornes JS, Morson BC (1961) Primary malignant lymphoid tumors of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg 49:80–89CrossRefPubMed
15.
go back to reference Behms KE, Sarr MG, Strickler JG (1994) Pancreatic lymphoma: is it a surgical disease? Pancreas 9:662–667CrossRef Behms KE, Sarr MG, Strickler JG (1994) Pancreatic lymphoma: is it a surgical disease? Pancreas 9:662–667CrossRef
16.
go back to reference Merkle EM, Bender GN, Brambs HJ (2000) Imaging findings in pancreatic lymphoma: differential aspects. Am J Roentgenol 174(3):671–675CrossRef Merkle EM, Bender GN, Brambs HJ (2000) Imaging findings in pancreatic lymphoma: differential aspects. Am J Roentgenol 174(3):671–675CrossRef
17.
go back to reference Van Beers B, Lalonde L, Soyer P, et al. (1993) Dynamic CT in pancreatic lymphoma. J Comput Assist Tomogr 17:94–97CrossRefPubMed Van Beers B, Lalonde L, Soyer P, et al. (1993) Dynamic CT in pancreatic lymphoma. J Comput Assist Tomogr 17:94–97CrossRefPubMed
19.
go back to reference Marchegiani G, Andrianello S, Massignani M, et al. (2016) Solid pseudopapillary tumors of the pancreas: specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol 114(5):597–601CrossRefPubMed Marchegiani G, Andrianello S, Massignani M, et al. (2016) Solid pseudopapillary tumors of the pancreas: specific pathological features predict the likelihood of postoperative recurrence. J Surg Oncol 114(5):597–601CrossRefPubMed
20.
go back to reference Buetow PC, Buck JL, Pantongrag-Brown L, et al. (1996) Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology 199(3):707–711CrossRefPubMed Buetow PC, Buck JL, Pantongrag-Brown L, et al. (1996) Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology 199(3):707–711CrossRefPubMed
21.
go back to reference Ganeshan DM, Paulson E, Tamm EP, et al. (2013) Solid pseudopapillary tumors of the pancreas: current update. Abdom Imaging 38:1373–1382CrossRefPubMed Ganeshan DM, Paulson E, Tamm EP, et al. (2013) Solid pseudopapillary tumors of the pancreas: current update. Abdom Imaging 38:1373–1382CrossRefPubMed
22.
go back to reference Cantisani V, Mortele KJ, Levy A, et al. (2003) MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. Am J Roentgenol 181(2):395–401CrossRef Cantisani V, Mortele KJ, Levy A, et al. (2003) MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. Am J Roentgenol 181(2):395–401CrossRef
23.
go back to reference Choi JY, Kim MJ, Kim JH, et al. (2006) Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. Am J Roentgenol 187(2):W178–W186CrossRef Choi JY, Kim MJ, Kim JH, et al. (2006) Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. Am J Roentgenol 187(2):W178–W186CrossRef
24.
go back to reference Tatli S, Mortele KJ, Levy AD, et al. (2005) CT and MRI features of pure acinar cell carcinoma of the pancreas in adults. Am J Roentgenol 184:511–519CrossRef Tatli S, Mortele KJ, Levy AD, et al. (2005) CT and MRI features of pure acinar cell carcinoma of the pancreas in adults. Am J Roentgenol 184:511–519CrossRef
25.
go back to reference Bhosale P, Balachandran A, Wang H, et al. (2013) CT imaging features of acinar cell carcinoma and its hepatic metastases. Abdom Imaging 38:1383–1390CrossRefPubMed Bhosale P, Balachandran A, Wang H, et al. (2013) CT imaging features of acinar cell carcinoma and its hepatic metastases. Abdom Imaging 38:1383–1390CrossRefPubMed
26.
go back to reference Chiou YY, Jen-Huey C, Jen-I H, et al. (2004) Acinar cell carcinoma of the pancreas: clinical and computed tomography manifestations. J Comput Assist Tomogr 28(2):180–186CrossRefPubMed Chiou YY, Jen-Huey C, Jen-I H, et al. (2004) Acinar cell carcinoma of the pancreas: clinical and computed tomography manifestations. J Comput Assist Tomogr 28(2):180–186CrossRefPubMed
27.
go back to reference Barral , et al. (2016) Imaging features of rare pancreatic tumors. Diagnos Interv Imaging 97:1259–1273CrossRef Barral , et al. (2016) Imaging features of rare pancreatic tumors. Diagnos Interv Imaging 97:1259–1273CrossRef
28.
go back to reference Choi JY, Kim MJ, Lee JY, et al. (2009) Typical and atypical manifestations of serous cystadenomas of the Pancreas: imaging findings with pathologic correlation. Am J Roentgenol 193:136–142CrossRef Choi JY, Kim MJ, Lee JY, et al. (2009) Typical and atypical manifestations of serous cystadenomas of the Pancreas: imaging findings with pathologic correlation. Am J Roentgenol 193:136–142CrossRef
29.
go back to reference Kim HJ, Lee DH, Ko YT, et al. (2008) CT of serous cystadenoma of the pancreas and mimicking masses. Am J Roentegnol 190:406–412CrossRef Kim HJ, Lee DH, Ko YT, et al. (2008) CT of serous cystadenoma of the pancreas and mimicking masses. Am J Roentegnol 190:406–412CrossRef
30.
31.
go back to reference Ginat DT, Bokhari A, Bhatt S, et al. (2011) Imaging features of solitary fibrous tumors. Am J Roentgenol 196:487–495CrossRef Ginat DT, Bokhari A, Bhatt S, et al. (2011) Imaging features of solitary fibrous tumors. Am J Roentgenol 196:487–495CrossRef
32.
go back to reference Ichikawa T, Sou H, Araki T, et al. (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221:107–116CrossRefPubMed Ichikawa T, Sou H, Araki T, et al. (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221:107–116CrossRefPubMed
33.
go back to reference Kim Jai K, Ersan Altun, Jorge Elias, et al. (2007) Focal pancreatic mass: Distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. JMRI 26(2):313–322CrossRefPubMed Kim Jai K, Ersan Altun, Jorge Elias, et al. (2007) Focal pancreatic mass: Distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. JMRI 26(2):313–322CrossRefPubMed
34.
go back to reference Fattahi R, Balci NC, Perman WH, et al. (2009) Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29(2):350–356CrossRefPubMed Fattahi R, Balci NC, Perman WH, et al. (2009) Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29(2):350–356CrossRefPubMed
35.
go back to reference Okazaki K, Uchida K, Koyabu M, Miyoshi H, et al. (2011) Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease. J Gastroenterol 46(3):277–288CrossRefPubMed Okazaki K, Uchida K, Koyabu M, Miyoshi H, et al. (2011) Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease. J Gastroenterol 46(3):277–288CrossRefPubMed
36.
go back to reference Shimosegawa T, Chari ST, Frulloni L, et al. (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40(3):352–358CrossRefPubMed Shimosegawa T, Chari ST, Frulloni L, et al. (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40(3):352–358CrossRefPubMed
37.
go back to reference Sahani DV, Kalva SP, Farrell J, et al. (2004) Autoimmune pancreatitis: imaging features. Radiology 233:345–352CrossRefPubMed Sahani DV, Kalva SP, Farrell J, et al. (2004) Autoimmune pancreatitis: imaging features. Radiology 233:345–352CrossRefPubMed
38.
go back to reference Vlachou PA, Khalili K, Jang HJ, et al. (2011) IgG4-related sclerosing disease: autoimmune pancreatitis and extrapancreatic manifestations. Radiographics 31(5):1379–1402CrossRefPubMed Vlachou PA, Khalili K, Jang HJ, et al. (2011) IgG4-related sclerosing disease: autoimmune pancreatitis and extrapancreatic manifestations. Radiographics 31(5):1379–1402CrossRefPubMed
39.
go back to reference Kamisawa T, Egawa N, Nakajima H, et al. (2003) Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98:2694–2699CrossRefPubMed Kamisawa T, Egawa N, Nakajima H, et al. (2003) Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98:2694–2699CrossRefPubMed
40.
go back to reference Itoh S, Yamakawa K, Shimamoto K, et al. (1994) CT findings in groove pancreatitis: correlation with histopathological findings. J Comput Assist Tomogr 18:911–915CrossRefPubMed Itoh S, Yamakawa K, Shimamoto K, et al. (1994) CT findings in groove pancreatitis: correlation with histopathological findings. J Comput Assist Tomogr 18:911–915CrossRefPubMed
41.
go back to reference Raman SP, Salaria SN, Hruban RH, et al. (2013) Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation. Am J Roentgenol 201(1):W29–W39CrossRef Raman SP, Salaria SN, Hruban RH, et al. (2013) Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation. Am J Roentgenol 201(1):W29–W39CrossRef
42.
go back to reference Kim HJ, Byun JH, Park SH, et al. (2007) Focal fatty replacement of the pancreas: usefulness of chemical shift MRI. Am J Roentgenol 188(2):429–432CrossRef Kim HJ, Byun JH, Park SH, et al. (2007) Focal fatty replacement of the pancreas: usefulness of chemical shift MRI. Am J Roentgenol 188(2):429–432CrossRef
43.
go back to reference Matsumoto S, Mori H, Miyake H, et al. (1995) Uneven fatty replacement of the pancreas: evaluation with CT. Radiology 194:453–458CrossRefPubMed Matsumoto S, Mori H, Miyake H, et al. (1995) Uneven fatty replacement of the pancreas: evaluation with CT. Radiology 194:453–458CrossRefPubMed
44.
go back to reference Atri M, Nazarnia S, Mehio A, et al. (1994) Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings. Radiology 190:441–444CrossRefPubMed Atri M, Nazarnia S, Mehio A, et al. (1994) Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings. Radiology 190:441–444CrossRefPubMed
45.
46.
go back to reference Sandrasegaran K, Patel A, Fogel EL, et al. (2009) Annular pancreas in adults. Am J Roentgenol 193(2):455–460CrossRef Sandrasegaran K, Patel A, Fogel EL, et al. (2009) Annular pancreas in adults. Am J Roentgenol 193(2):455–460CrossRef
Metadata
Title
Imaging mimics of pancreatic ductal adenocarcinoma
Authors
Namita S. Gandhi
Myra K. Feldman
Ott Le
Gareth Morris-Stiff
Publication date
01-02-2018
Publisher
Springer US
Published in
Abdominal Radiology / Issue 2/2018
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-017-1330-1

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