Learning objectives
- To inform pancreas adenocarcinoma mimicking pancreatic lesions and neoplasms.
- To provide imaging clues for differentiation between PA and its mimics.
Background
Pancras adenocarcinoma (PA) accounts for 85-90% of all pancreatic neoplasms and is one of the leading causes of death worldwide. A variety of pancreatic lesions mimic pancreas adenocarcinoma (PA). Benign, congenital, chronic inflammatory and neoplasticdiseases can mimic PA and these occasionally look similar in images. Due to this, rate of misdiagnoses of pancreatic adenocarcinoma range from 1.6% to 30%. But they have several differential diagnosis points.
The purpose of this educational exhibit is to provide thekey findingsthat suggest the correct diagnosis.
Findings and procedure details
1. Pancreatic adenocarcinoma
Pancreatic adenocarcinoma (PA) usually appear as low attenuating masses in the pancreatic and portal venous phases. These lesions typically accompany pancreatic duct dilatation with abrupt narrowing. (figure 1)
Major feature
Age/Sex :>60 years, Male>Female
Enhancing pattern :progressive enhancement with hypovascular core
P-duct morphology :pancreatic duct abrupt cut-off or dilatation
Ancillary feature
Increased CA19-9
Infiltrative border
2. Inflammatory mimics
Focal autoimmune pancreatitis (IgG4-related)
Autoimmune pancreatitis (AIP) is an uncommon form of chronic pnacreatitis caused by autoimmune mechanism. It is one of the most...
Conclusion
The radiologists should understand useful imaging findings of spectrums of pancreatid adenocarcinoma and mimickers to differentiate diagnosis.
Understanding imaging findings plays an important role in proper management of the patients.
Personal information and conflict of interest
Dr.Hyunwoo Cho
Resident in 4th year, Radiology Department, Dong-A university medical center, Busan, Republic of Korea
Dr.Heejin Kwon
Proffesor of radiology, Radiology Department, Dong-A university medical center, Busan, Republic of Korea
Dr.Jinhan Cho
Proffesor of radiology, Radiology Department, Dong-A university medical center, Busan, Republic of Korea
References
Kim SS, et al. Pancreas ductal adenocarcinoma and its mimics : Review of cross-sectional imaging findings for differential diagnosis. Journal of the belgian society of radiology. 2018; 102(1): 71, 1–8. DOI: https://doi.org/10.5334/jbsr.1644.
Tonolini Massimo, MD; Matacena Giovanni. Focal mass-forming chronic pancreatitis: indistinguishable from pancreatic carcinoma? 10.1594/EURORAD/CASE.14732.
Birol baysal, et al. Primary pancreatic lymphoma: A rare cause of pancreatic mass. Oncology letters 10: 1701-1703, 2015.DOI: 10.3892/ol.2015.3412.
Fergus V. Coakley. et al. Pancreatic Imaging Mimics: Part 1, Imaging Mimics of Pancreatic Adenocarcinoma. American Journal of Roentgenology 199:301–308(2012)....