Skip to main content
SpringerLink
Log in

Uncommon pancreatic tumors and pseudotumors

  • Pictorial Essay
  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

A heterogeneous group of uncommon neoplastic and non-neoplastic pancreatic pathologies exists that can mimic pancreatic adenocarcinoma. These “imitators” are unique and may demonstrate characteristic clinical and imaging features. Imaging characteristics of some of these diverse lesions are not well described in the literature, and erroneous diagnoses of these entities as pancreatic carcinoma may be responsible for unnecessary surgeries. Knowledge of these selected pancreatic pathologies is essential to facilitate optimal patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24

Similar content being viewed by others

References

  1. Patlas M, Deitel W, Taylor B, Gallinger S, Wilson SR (2007) Focal chronic pancreatitis mimicking pancreatic head carcinoma: are there suggestive features on ultrasound? Can Assoc Radiol J = Journal l’Association canadienne des radiologistes 58(1):15–21

    Google Scholar 

  2. Ichikawa T, Federle MP, Ohba S, et al. (2000) Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell, and giant cell types): CT and pathologic features in 14 patients. Abdom Imaging 25(4):409–419

    Article  CAS  PubMed  Google Scholar 

  3. Kalra MK, Maher MM, Mueller PR, Saini S (2003) State-of-the-art imaging of pancreatic neoplasms. Br J Radiol 76(912):857–865

    Article  CAS  PubMed  Google Scholar 

  4. Coakley FV, Hanley-Knutson K, Mongan J, et al. (2012) Pancreatic imaging mimics: part 1, imaging mimics of pancreatic adenocarcinoma. AJR Am J Roentgenol 199(2):301–308. doi:10.2214/AJR.11.7907

    Article  PubMed  Google Scholar 

  5. Proctor RD, Rofe CJ, Bryant TJ, Hacking CN, Stedman B (2013) Autoimmune pancreatitis: an illustrated guide to diagnosis. Clin Radiol 68(4):422–432. doi:10.1016/j.crad.2012.08.016

    Article  CAS  PubMed  Google Scholar 

  6. Shah S, Mortele KJ (2007) Uncommon solid pancreatic neoplasms: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 28(5):357–370

    Article  PubMed  Google Scholar 

  7. Mortenson MM, Katz MH, Tamm EP, et al. (2008) Current diagnosis and management of unusual pancreatic tumors. Am J Surg 196(1):100–113. doi:10.1016/j.amjsurg.2008.02.005

    Article  PubMed  Google Scholar 

  8. Mannelli L, Yeh MM, Wang CL (2012) A pregnant patient with hypoglycemia. Gastroenterology 143(4):e3–e4. doi:10.1053/j.gastro.2012.03.051

    Article  PubMed  Google Scholar 

  9. Poruk KE, Gay DZ, Brown K, et al. (2013) The clinical utility of CA 19-9 in pancreatic adenocarcinoma: diagnostic and prognostic updates. Curr Mol Med 13(3):340–351

    CAS  PubMed  Google Scholar 

  10. Perez-Johnston R, Sainani NI, Sahani DV (2012) Imaging of chronic pancreatitis (including groove and autoimmune pancreatitis). Radiol Clin North Am 50(3):447–466. doi:10.1016/j.rcl.2012.03.005

    Article  PubMed  Google Scholar 

  11. Kim T, Murakami T, Takamura M, et al. (2001) Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR Am J Roentgenol 177(2):367–371. doi:10.2214/ajr.177.2.1770367

    Article  CAS  PubMed  Google Scholar 

  12. Perez-Johnston R, Narin O, Mino-Kenudson M, et al. (2013) Frequency and significance of calcification in IPMN. Pancreatology 13(1):43–47. doi:10.1016/j.pan.2012.11.306

    Article  CAS  PubMed  Google Scholar 

  13. Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. (2012) 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery 152(3 Suppl 1):S4–12. doi:10.1016/j.surg.2012.05.033

    Article  PubMed Central  PubMed  Google Scholar 

  14. Yadav D, Lowenfels AB (2013) The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 144(6):1252–1261. doi:10.1053/j.gastro.2013.01.068

    Article  PubMed Central  PubMed  Google Scholar 

  15. Howes N, Neoptolemos JP (2002) Risk of pancreatic ductal adenocarcinoma in chronic pancreatitis. Gut 51(6):765–766

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Blouhos K, Boulas KA, Tselios DG, et al. (2013) Surgically proved visually isoattenuating pancreatic adenocarcinoma undetected in both dynamic CT and MRI. Was blind pancreaticoduodenectomy justified? Int J Surg Case Rep 4(5):466–469. doi:10.1016/j.ijscr.2013.02.010

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kim JH, Park SH, Yu ES, et al. (2010) Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology 257(1):87–96. doi:10.1148/radiol.10100015

    Article  PubMed  Google Scholar 

  18. Talamini G, Bassi C, Falconi M, et al. (1999) Early detection of pancreatic cancer following the diagnosis of chronic pancreatitis. Digestion 60(6):554–561

    Article  CAS  PubMed  Google Scholar 

  19. Talamini G, Falconi M, Bassi C, et al. (1999) Incidence of cancer in the course of chronic pancreatitis. Am J Gastroenterol 94(5):1253–1260. doi:10.1111/j.1572-0241.1999.01075.x

    Article  CAS  PubMed  Google Scholar 

  20. 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(1):107–116

    Article  CAS  PubMed  Google Scholar 

  21. Bodily KD, Takahashi N, Fletcher JG, et al. (2009) Autoimmune pancreatitis: pancreatic and extrapancreatic imaging findings. AJR Am J Roentgenol 192(2):431–437. doi:10.2214/AJR.07.2956

    Article  PubMed  Google Scholar 

  22. Sahani DV, Kalva SP, Farrell J, et al. (2004) Autoimmune pancreatitis: imaging features. Radiology 233(2):345–352. doi:10.1148/radiol.2332031436

    Article  PubMed  Google Scholar 

  23. Shanbhogue AK, Fasih N, Surabhi VR, et al. (2009) A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics 29(4):1003–1026. doi:10.1148/rg.294085748

    Article  PubMed  Google Scholar 

  24. Kawamoto S, Johnson PT, Hall H, et al. (2012) Intrapancreatic accessory spleen: CT appearance and differential diagnosis. Abdom Imaging 37(5):812–827. doi:10.1007/s00261-011-9830-x

    Article  PubMed  Google Scholar 

  25. Ota T, Ono S (2004) Intrapancreatic accessory spleen: diagnosis using contrast enhanced ultrasound. Br J Radiol 77(914):148–149

    Article  CAS  PubMed  Google Scholar 

  26. Colagrande S, Belli G, Politi LS, et al. (2008) The influence of diffusion- and relaxation-related factors on signal intensity: an introductive guide to magnetic resonance diffusion-weighted imaging studies. J Comput Assist Tomogr 32(3):463–474. doi:10.1097/RCT.0b013e31811ec6d4

    Article  PubMed  Google Scholar 

  27. Hwang HS, Lee SS, Kim SC, Seo DW, Kim J (2011) Intrapancreatic accessory spleen: clinicopathologic analysis of 12 cases. Pancreas 40(6):956–965. doi:10.1097/MPA.0b013e318216815b

    Article  PubMed  Google Scholar 

  28. Kim SH, Lee JM, Han JK, et al. (2008) Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol 9(2):162–174. doi:10.3348/kjr.2008.9.2.162

    Article  PubMed Central  PubMed  Google Scholar 

  29. Rosseel F, Brugman E, Fiey J, et al. (1996) Total fat replacement of the pancreas: case report and review of the literature. Journal Belge de Radiologie 79(5):199–200

    CAS  PubMed  Google Scholar 

  30. Dubois J, Guy F, Porcheron J (2003) A pancreatic-induced intramural duodenal hematoma: a case report and literature review. Hepato-gastroenterology 50(53):1689–1692

    CAS  PubMed  Google Scholar 

  31. Ma JK, Ng KK, Poon RT, Fan ST (2008) Pancreatic-induced intramural duodenal haematoma. Asian J Surg/Asian Surg Assoc 31(2):83–86. doi:10.1016/S1015-9584(08)60063-9

    Article  Google Scholar 

  32. Sunkara S, Williams TR, Myers DT, Kryvenko ON (2012) Solid pseudopapillary tumours of the pancreas: spectrum of imaging findings with histopathological correlation. Br J Radiol 85(1019):e1140–e1144. doi:10.1259/bjr/20695686

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Ulusan S, Bal N, Kizilkilic O, et al. (2005) Case report: solid-pseudopapillary tumour of the pancreas associated with dorsal agenesis. Br J Radiol 78(929):441–443. doi:10.1259/bjr/91312352

    Article  CAS  PubMed  Google Scholar 

  34. Cantisani V, Mortele KJ, Levy A, et al. (2003) MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR Am J Roentgenol 181(2):395–401. doi:10.2214/ajr.181.2.1810395

    Article  PubMed  Google Scholar 

  35. Kersting S, Janot MS, Munding J, et al. (2012) Rare solid tumors of the pancreas as differential diagnosis of pancreatic adenocarcinoma. JOP 13(3):268–277

    PubMed  Google Scholar 

  36. Pajak J, Liszka L, Mrowiec S, et al. (2011) Serous neoplasms of the pancreas constitute a continuous spectrum of morphological patterns rather than distinct clinico-pathological variants. A study of 40 cases. Pol J Pathol 62(4):206–217

    PubMed  Google Scholar 

  37. Farrell JJ, Fernandez-del Castillo C (2013) Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology 144(6):1303–1315. doi:10.1053/j.gastro.2013.01.073

    Article  PubMed  Google Scholar 

  38. Parra-Herran CE, Garcia MT, Herrera L, Bejarano PA (2010) Cystic lesions of the pancreas: clinical and pathologic review of cases in a five year period. JOP 11(4):358–364

    PubMed  Google Scholar 

  39. Klein KA, Stephens DH, Welch TJ (1998) CT characteristics of metastatic disease of the pancreas. Radiographics 18(2):369–378

    Article  CAS  PubMed  Google Scholar 

  40. Rosenkrantz AB, Mannelli L, Mossa D, Babb JS (2011) Breath-hold T2-weighted MRI of the liver at 3T using the BLADE technique: impact upon image quality and lesion detection. Clin Radiol 66(5):426–433. doi:10.1016/j.crad.2010.10.018

    Article  CAS  PubMed  Google Scholar 

  41. Tatli S, Mortele KJ, Levy AD, et al. (2005) CT and MRI features of pure acinar cell carcinoma of the pancreas in adults. AJR Am J Roentgenol 184(2):511–519. doi:10.2214/ajr.184.2.01840511

    Article  PubMed  Google Scholar 

  42. Chung WS, Park MS, Kim DW, Kim KW (2011) Case report. Acinar cell carcinoma with fatty change arising from the pancreas. Br J Radiol 84(1008):e226–e228. doi:10.1259/bjr/15914752

    Article  PubMed Central  PubMed  Google Scholar 

  43. Merkle EM, Bender GN, Brambs HJ (2000) Imaging findings in pancreatic lymphoma: differential aspects. AJR Am J Roentgenol 174(3):671–675. doi:10.2214/ajr.174.3.1740671

    Article  CAS  PubMed  Google Scholar 

  44. Battula N, Srinivasan P, Prachalias A, Rela M, Heaton N (2006) Primary pancreatic lymphoma: diagnostic and therapeutic dilemma. Pancreas 33(2):192–194. doi:10.1097/01.mpa.0000227910.63579.15

    Article  PubMed  Google Scholar 

  45. Schneider G, Seidel R, Altmeyer K, et al. (2001) Lymphangioma of the pancreas and the duodenal wall: MR imaging findings. Eur Radiol 11(11):2232–2235. doi:10.1007/s003300100846

    Article  CAS  PubMed  Google Scholar 

  46. Ferrozzi F, Zuccoli G, Bova D, Calculli L (2000) Mesenchymal tumors of the pancreas: CT findings. J Comput Assist Tomogr 24(4):622–627

    Article  CAS  PubMed  Google Scholar 

  47. Osman S, Lehnert BE, Elojeimy S, et al. (2013) A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol 42(5):191–208. doi:10.1067/j.cpradiol.2013.02.001

    Article  PubMed  Google Scholar 

  48. Poosawang W, Kiatkungwankai P (2013) Pancreatic schwannoma: a case report and review of literature. J Med Assoc Thail = Chotmaihet thangphaet 96(1):112–116

    Google Scholar 

  49. Ferrozzi F, Bova D, Garlaschi G (1995) Pancreatic schwannoma: report of three cases. Clin Radiol 50(7):492–495

    Article  CAS  PubMed  Google Scholar 

  50. Katz DS, Nardi PM, Hines J, et al. (1998) Lipomas of the pancreas. AJR Am J Roentgenol 170(6):1485–1487. doi:10.2214/ajr.170.6.9609158

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors sincerely thank Patrick Freeny, M.D. for his valuable contributions.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington, Seattle, WA, 98104-2499, USA

    Neeraj Lalwani, Lorenzo Mannelli, Manjiri K. Dighe & Suresh Maximin

  2. University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Dhakshina Moorthy Ganeshan & Srinivasa R. Prasad

  3. Department of Radiology, Beth Israel Medical Center, New York, NY, USA

    Alampady K. Shanbhogue

  4. Department of Radiology, University of Arizona, Tucson, AZ, USA

    Hina Arif Tiwari

  5. IRCCS Fondazione SDN, Naples, Italy

    Serena Monti & Monica Ragucci

Authors
  1. Neeraj Lalwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorenzo Mannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dhakshina Moorthy Ganeshan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alampady K. Shanbhogue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manjiri K. Dighe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hina Arif Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suresh Maximin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Serena Monti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Monica Ragucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Srinivasa R. Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neeraj Lalwani.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lalwani, N., Mannelli, L., Ganeshan, D.M. et al. Uncommon pancreatic tumors and pseudotumors. Abdom Imaging 40, 167–180 (2015). https://doi.org/10.1007/s00261-014-0189-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-014-0189-7

Keywords

Search

Navigation