Imaging Pearls ❯ Pancreas ❯ Miscellaneous
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- “Though PH lesions may be located anywhere within the gastrointestinal tract, 90% occur in the upper tract. Common sites of occurrence include the stomach (25- 36%), duodenum (17-36%), and jejunum (15-22%). Within the stomach, 85-95% are located in the antrum, predominantly the greatercurvature. Additional sites of occurrence include the esophagus, gallbladder, common bile duct, liver,omentum, Meckel’s diverticulum, lungs, mediastinum, fallopian tubes, umbilicus and brain.”
Pancreatic Heterotopia: Masquerading as Malignancy - A 15-Year Single Institutional Surgicalpathology Review
Rani Kanthan et al.
JOP. Journal of the Pancreas - Vol. 16 No. 4 – Jul 2015 - “Lesions often appear as an intramural nodule or sessile polyp with central umbilication atendoscopy. These lesions may mimic intestinal carcinoid tumors, fibromas, eosinophilicgranulomas, granular cell myoblastomas, or malignancies.”
Pancreatic Heterotopia: Masquerading as Malignancy - A 15-Year Single Institutional Surgicalpathology Review
Rani Kanthan et al.
JOP. Journal of the Pancreas - Vol. 16 No. 4 – Jul 2015 - “In conclusion, pancreatic heterotopia is rare and often an incidental asymptomatic finding; however,patients presenting with a mass suggestive of malignancy, continues to pose clinical challenges and remains a diagnostic dilemma despite advances in investigative techniques. Accurate identification of PH mass-lesions is critical to guide patient management; as such lesions are oftenincorrectly identified as a metastatic tumor or an extension/recurrence of a neighboring malignancy. Awareness of this anomaly is of particular importanc.”
Pancreatic Heterotopia: Masquerading as Malignancy - A 15-Year Single Institutional Surgicalpathology Review
Rani Kanthan et al.
JOP. Journal of the Pancreas - Vol. 16 No. 4 – Jul 2015
- Celiac Plexus Neurolysis
Celiac plexus neurolysis (CPN) is a technique that can potentially improve pain control in pancreatic cancer while preventing further escalation of opioid consumption. CPN is performed by injecting absolute alcohol into the celiac plexus neural network of ganglia. - “Celiac plexus neurolysis (CPN) is a technique that can potentially improve pain control in pancreatic cancer while preventing further escalation of opioid consumption. CPN is performed by injecting absolute alcohol into the celiac plexus neural network of ganglia.” Celiac plexus neurolysis in the management of unresectable pancreatic cancer: When and how? Jonathan M Wyse, Yen-I Chen, and Anand V Sahai World J Gastroenterol. 2014 Mar 7; 20(9): 2186–2192.
- “CPN is most often performed by injecting local anesthetic followed by absolute alcohol into the celiac plexus neural network of ganglia with intention to ablate the tissue transmitting pain from the pancreas and adjacent visceral organs. In current clinical practice, it has been used almost exclusively as salvage therapy when pain control is inadequate with SAT.”
Celiac plexus neurolysis in the management of unresectable pancreatic cancer: When and how? Jonathan M Wyse, Yen-I Chen, and Anand V Sahai World J Gastroenterol. 2014 Mar 7; 20(9): 2186–2192. - EUS-CPN has emerged as a promising approach to CPN that has the potential for better visualization of the celiac plexus through close proximity and real-time high-resolution ultrasound, possibly allowing for more precise and safer injections. However, the data supporting this approach once again in the context of salvage therapy are limited to uncontrolled retrospective studies.
Celiac plexus neurolysis in the management of unresectable pancreatic cancer: When and how? Jonathan M Wyse, Yen-I Chen, and Anand V Sahai World J Gastroenterol. 2014 Mar 7; 20(9): 2186–2 - “Although there are no head to head trials comparing EUS to PQ-CPN, data comparing the two modalities for CPB in chronic pancreatitis suggests EUS may be superior. Despite no conclusive data suggesting superiority, EUS does offer the potential for enhanced visualization of important vital structures and of celiac ganglia should CGN studies become more robust. Given the sum of the evidence and with wider distribution of ethanol in areas where ganglia are known to reside, we favor bilateral CPN over central injection.”
Celiac plexus neurolysis in the management of unresectable pancreatic cancer: When and how? Jonathan M Wyse, Yen-I Chen, and Anand V Sahai World J Gastroenterol. 2014 Mar 7; 20(9): 2186–2
- “Pancreatic hamartoma is considered as a strictly benign malformation rather than a tumor. Pancreatic hamartoma has no gender predilection and may present as a solid, or solid and cystic lesion. Most of pancreatic hamartomas are located in the pancreatic head . Pathologically, pancreatic hamartomas is a well- demarcated mass consisting of mature acini and ducts with distorted architecture embedded in a fibrous stroma. The solid component of the tumor consists of fibrous and adipose tissue, whereas the cystic component consists of dilated ducts. Islets cells of Langerhans may be present. Tumor serum markers are usually normal.”
Imaging features of rare pancreatic tumors M. Barrala, S.A. Faraound, E.K. Fishman, A. Dohan, C. Pozzesserea, M.-A. Berthelina,P. Bazeries, M. Barat, C. Hoeffel, P. Soyer Diagnostic and Interventional Imaging (2016) (in press) - “The pancreas is a rare location of lipoma. Head and tail of the pancreas are the most frequent locations . Embryological theory suggests a trapping of the retroperitoneal or mesenteric fat during the fusion of the ventral and dorsal bud of the pancreas. It is mostly composed of lobules of mature adipose cells with a thick connective tis- sue capsule [46]. It has characteristic imaging features so that histological biopsy sample is not needed for a definite diagnosis.”
Imaging features of rare pancreatic tumors M. Barrala, S.A. Faraound, E.K. Fishman, A. Dohan, C. Pozzesserea, M.-A. Berthelina,P. Bazeries, M. Barat, C. Hoeffel, P. Soyer Diagnostic and Interventional Imaging (2016) (in press)
- Pseudolesions Mimicking Primary Pancreatic Neoplasia
- Pancreatic Head, Body or Tail
- Vascular lesion like aneurysms or pseudoaneurysm (ranging from hepatic artery to
splenic artery)
- Metastatic disease near pancreas
- Adenopathy in peripancreatic region - Pseudolesions Mimicking Primary Pancreatic Neoplasia
- Pancreatic Tail
- Accessory spleen
- Gastric fundus tumors
- Small bowel masses
- Left adrenal mass
- Left renal mass
- Colonic mass
- Mesenteric mass - Pseudolesions Mimicking Primary Pancreatic Neoplasia
- Pancreatic Body
- Pseudoocysts
- Gastric tumors
- Duodenal tumors including GIST and adenocarcinoma - Pseudolesions Mimicking Primary Pancreatic Neoplasia
- Pancreatic Head
- Autoimmune pancreatitis
- Annular pancreas
- Grove pancreatitis
- Pancreas divisum
- Duodenal diverticula
- Duodenal tumors (GIST, adenocarcinoma)
- Adenopathy - “ It is important that the radiologist be familiar with the wide spectrum of anatomic variants and
disease entities that can mimic primary pancreatic neoplasia in order to initiate the appropriate
lesion-specific work-up and treatment and avoid unnecessary tests or procedures, including
surgery.”
Pancreatic and Peripancreatic Disease Mimicking Primary Pancreatic Neoplasia
To’o KJ et al.
RadioGraphics 2005;25:949-965 - Vascular Lesions of the Pancreas (and Pseudolesions)
- Neuroendocrine tumors
- Acinar cell carcinoma
- Hemorrhagic pancreatitis
- Peripancreatic pseudoaneurysm
- Peripancreatic varices
- Accessory spleen "Pancreatic involvement commonly is found in patients with HHT (31% in our study), mainly in patients with ALK1 mutation; pancreatic telangiectases or AVMs are only diagnosed during the arterial phase at multidetector CT."
Pancreatic Involvement in Hereditary Hemorrhagic Telangiectasia: Assessment with Multidetector Helical CT
Lacout A et al.
Radiology 2010; 254:479-484