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European Radiology
Published in: European Radiology 5/2012

01-05-2012 | Gastrointestinal

Adenocarcinoma of the uncinate process of the pancreas: MDCT patterns of local invasion and clinical features at presentation

Authors: Amie E. Padilla-Thornton, Jürgen K. Willmann, R. Brooke Jeffrey

Published in: European Radiology | Issue 5/2012

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Abstract

Objective

To compare the multidetector CT (MDCT) patterns of local invasion and clinical findings at presentation in patients with adenocarcinoma of the uncinate process of the pancreas to patients with adenocarcinomas in the non-uncinate head of the pancreas.

Methods

We evaluated the two cohorts for common duct and pancreatic duct dilatation, mesenteric vascular encasement, root of mesentery invasion, perineural invasion and duodenal invasion. In addition, we compared the clinical findings at presentation in both groups.

Results

Common duct (P < 0.001) and pancreatic duct dilatation (P = 0.001) were significantly less common in uncinate process adenocarcinomas than in the non-uncinate head of the pancreas. Clinical findings of jaundice (P = 0.01) and pruritis (P = 0.004) were significantly more common in patients with lesions in the non-uncinate head of the pancreas. Superior mesenteric artery encasement (P = 0.02) and perineural invasion (P = 0.001) were significantly more common with uncinate process adenocarcinomas.

Conclusion

Owing to its unique anatomic location, adenocarcinomas within the uncinate process of the pancreas have significantly different patterns of both local invasion and clinical presentation compared to patients with carcinomas in the non-uncinate head of the pancreas.
Key Points
• SMA encasement and perineural invasion were more common with uncinate process adenocarcinomas.
• Common bile duct and pancreatic duct dilatation were less common in uncinate process adenocarcinomas
• Jaundice and pruritis were more common with lesions elsewhere in the pancreatic head
Literature
1.
Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15PubMedCrossRef
2.
Birk D, Schoenberg MH, Gansauge F et al (1998) Carcinoma of the head of the pancreas arising from the uncinate process. Br J Surg 85:498–501PubMedCrossRef
3.
Suzuki T, Kuratsuka H, Uchida K et al (1972) Carcinoma of the pancreas arising in the region of the uncinate process. Cancer 30:796–800PubMedCrossRef
4.
Li S, Pei YQ, Du FT et al (2002) Surgical treatment for uncinate process carcinoma of the pancreas. Hepatobiliary Pancreat Dis Int 1:592–594PubMed
5.
Ye C, Xi PC, Hu XG et al (2003) Clinical analysis of uncinate process carcinoma of the pancreas. Hepatobiliary Pancreat Dis Int 2:605–608PubMed
6.
O’Sullivan AW, Heaton N, Rela M (2009) Cancer of the uncinate process of the pancreas: surgical anatomy and clinicopathological features. Hepatobiliary Pancreat Dis Int 8:569–572PubMed
7.
Kang MJ, Jang J-Y, Lee SE et al (2010) Comparison of the long-term outcomes of uncinate process cancer and non-uncinate process pancreas head cancer: poor prognosis accompanied by early locoregional recurrence. Langenbecks Arch Surg 395:697–706PubMedCrossRef
8.
Lu DSK, Reber HA, Krasny RM et al (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 168:1439–1443PubMed
9.
Hough TJ, Raptopoulos V, Siewert B, Matthews JB (1999) Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. AJR Am J Roentgenol 173:1509–1512PubMed
10.
Deshmukh SD, Willmann JK, Jeffrey RB (2010) Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. AJR Am J Roentgenol 194:668–674PubMedCrossRef
11.
Tian H, Mori H, Matsumoto S et al (2007) Extrapancreatic neural plexus invasion by carcinomas of the pancreatic head region: evaluation using thin-section helical CT. Radiat Med 25:141–147PubMedCrossRef
12.
Hirai I, Kimura W, Ozawa K et al (2002) Perineural invasion in pancreatic cancer. Pancreas 24:15–25PubMedCrossRef
13.
Nagakawa T, Kayahara M, Ohta T et al (1991) Patterns of neural and plexus invasion of human pancreatic cancer and experimental cancer. Int J Pancreatol 10:113–119PubMed
14.
Kayahara M, Nagakawa T, Konishi I et al (1991) Clinicopathological study of pancreatic carcinoma with particular reference to the invasion of the extrapancreatic neural plexus. Int J Pancreatol 10:105–111PubMed
15.
Nakao A, Harada A, Nonami T et al (1996) Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 12:357–361PubMedCrossRef
16.
Makino I, Kitagawa H, Ohta T et al (2008) Nerve plexus invasion in pancreatic cancer: spread patterns on histopathologic and embryological analyses. Pancreas 37:358–365PubMedCrossRef
17.
Yi SQ, Miwa K, Ohta T et al (2003) Innervation of the pancreas from the perspective of perineural invasion of pancreatic cancer. Pancreas 27:225–229PubMedCrossRef
18.
Atri M, Nazarnia S, Mehlo 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 190:441–444PubMed
19.
Mochizuki K, Gabata T, Kozaka K et al (2010) MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: correlation with en bloc specimens and diagnostic accuracy. Eur Radiol 20:1757–1767PubMedCrossRef
Metadata
Title
Adenocarcinoma of the uncinate process of the pancreas: MDCT patterns of local invasion and clinical features at presentation
Authors
Amie E. Padilla-Thornton
Jürgen K. Willmann
R. Brooke Jeffrey
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 5/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2339-4

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