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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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2
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Taya M, Hecht EM, Huang C, Lo GC. Pancreatic Cystic Lesions: Imaging Techniques and Diagnostic Features. Gastrointest Endosc Clin N Am 2023; 33:497-518. [PMID: 37245932 DOI: 10.1016/j.giec.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The detection of incidental pancreatic cystic lesions has increased over time. It is crucial to separate benign from potentially malignant or malignant lesions to guide management and reduce morbidity and mortality. The key imaging features used to fully characterize cystic lesions are optimally assessed by contrast-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography, with pancreas protocol computed tomography offering a complementary role. While some imaging features have high specificity for a particular diagnosis, overlapping imaging features between diagnoses may require further investigation with follow-up diagnostic imaging or tissue sampling.
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Affiliation(s)
- Michio Taya
- Department of Radiology, New York Presbyterian - Weill Cornell Medicine, 520 East 70th Street, Starr 8a, New York, NY 10021, USA
| | - Elizabeth M Hecht
- Department of Radiology, New York Presbyterian - Weill Cornell Medicine, 520 East 70th Street, Starr 8a, New York, NY 10021, USA
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, 560 1st Avenue, 2F, New York, NY 10016, USA
| | - Grace C Lo
- Department of Radiology, New York Presbyterian - Weill Cornell Medicine, 520 East 70th Street, Starr 8a, New York, NY 10021, USA.
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Takeda E, Kimura J, Okabayashi T, Sui K, Tabuchi M, Murokawa T, Iwata J. Clinicopathological features and surgical outcomes of pancreatic metastasis from thyroid cancer. Am J Surg 2022; 224:856-862. [DOI: 10.1016/j.amjsurg.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
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Okamoto T. Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer. World J Gastroenterol 2022; 28:985-1008. [PMID: 35431494 PMCID: PMC8968522 DOI: 10.3748/wjg.v28.i10.985] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
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Utility of CT to Differentiate Pancreatic Parenchymal Metastasis from Pancreatic Ductal Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13133103. [PMID: 34206263 PMCID: PMC8268077 DOI: 10.3390/cancers13133103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/29/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The purpose of this retrospective study was to report the computed tomography (CT) features of pancreatic parenchymal metastasis (PPM) and identify CT features that may help discriminate between PPM and PDAC. At multivariable analysis, well-defined margins (OR, 6.64; 95% CI: 1.47–29.93; p = 0.014), maximal enhancement during arterial phase (OR, 6.15; 95% CI: 1.13–33.51; p = 0.036), no vessel involvement (OR, 7.19; 95% CI: 1.51–34.14) and no Wirsung duct dilatation (OR, 10.63; 95% CI: 2.27–49.91) were independently associated with PPM. A nomogram based on CT features identified at multivariable analysis yielded an AUC of 0.92 (95% CI: 0.85–0.98) for the diagnosis of PPM vs. PDAC. Abstract Purpose: To report the computed tomography (CT) features of pancreatic parenchymal metastasis (PPM) and identify CT features that may help discriminate between PPM and pancreatic ductal adenocarcinoma (PDAC). Materials and methods: Thirty-four patients (24 men, 12 women; mean age, 63.3 ± 10.2 [SD] years) with CT and histopathologically proven PPM were analyzed by two independent readers and compared to 34 patients with PDAC. Diagnosis performances of each variable for the diagnosis of PPM against PDAC were calculated. Univariable and multivariable analyses were performed. A nomogram was developed to diagnose PPM against PDAC. Results: PPM mostly presented as single (34/34; 100%), enhancing (34/34; 100%), solid (27/34; 79%) pancreatic lesion without visible associated lymph nodes (24/34; 71%) and no Wirsung duct enlargement (29/34; 85%). At multivariable analysis, well-defined margins (OR, 6.64; 95% CI: 1.47–29.93; p = 0.014), maximal enhancement during arterial phase (OR, 6.15; 95% CI: 1.13–33.51; p = 0.036), no vessel involvement (OR, 7.19; 95% CI: 1.512–34.14) and no Wirsung duct dilatation (OR, 10.63; 95% CI: 2.27–49.91) were independently associated with PPM. The nomogram yielded an AUC of 0.92 (95% CI: 0.85–0.98) for the diagnosis of PPM vs. PDAC. Conclusion: CT findings may help discriminate between PPM and PDAC.
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Balasubramaniam R, Sammut JS, Britton I. Metastatic small cell lung cancer presenting as acute pancreatitis: Diagnosis with magnetic resonance cholangiopancreatography. Radiol Case Rep 2020; 15:2250-2254. [PMID: 32963663 PMCID: PMC7490978 DOI: 10.1016/j.radcr.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 10/25/2022] Open
Abstract
We detail a case of a right hilar small cell lung cancer with pancreatic metastases presenting as acute pancreatitis and being diagnosed on Magnetic Resonance Cholangiopancreatography (MRCP). A 59-year-old male patient had an MRCP performed following an initial computed tomography scan of the abdomen as part of the investigations following admission with acute pancreatitis. The diagnosis was not clear on CT but MRCP was able to confirm the likely diagnosis of pancreatic metastases with primary lung cancer as the underlying cause. The case illustrates the clinical radiological conundrum concurrent acute pancreatitis can produce to the diagnosis of pancreatic metastases along with how the superior tissue characterization of MRI despite the absence of intravenous contrast can be utilized to better identify solid pancreatic lesions and contribute towards the diagnosis. The superior field of view T2 coronal and localizer images on MRCP, compared to other standard abdominal imaging modalities, in this scenario enabled the right hilar lung primary to be diagnosed.
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Affiliation(s)
| | - John S Sammut
- Royal Stoke University Hospital, Newcastle road, Stoke-on-Trent, UK ST4 6QG
| | - Ingrid Britton
- Royal Stoke University Hospital, Newcastle road, Stoke-on-Trent, UK ST4 6QG
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Galia M, Albano D, Picone D, Terranova MC, Agrusa A, Di Buono G, Licata A, Lo Re G, La Grutta L, Midiri M. Imaging features of pancreatic metastases: A comparison with pancreatic ductal adenocarcinoma. Clin Imaging 2018; 51:76-82. [DOI: 10.1016/j.clinimag.2018.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 12/29/2022]
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Nogueira M, Dias SC, Silva AC, Pinto J, Machado J. Solitary pancreatic renal cell carcinoma metastasis. AUTOPSY AND CASE REPORTS 2018; 8:e2018023. [PMID: 30046549 PMCID: PMC6020126 DOI: 10.4322/acr.2018.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
Pancreatic metastases are rare; they account for only 2% of all pancreatic malignancies and usually occur when associated with a disseminated metastatic disease. Solitary pancreatic metastases are even less frequent, and there are few reports regarding surgical resection. We report the case of a 77-year-old female patient diagnosed with a single cephalo-pancreatic metastasis of renal cell carcinoma, 16 years after a total nephrectomy. The patient underwent successful pancreaticoduodenectomy, and the diagnosis was confirmed. A subsequent positron emission tomography (PET) scan showed disease relapse, and tyrosine kinase inhibitor treatment with sunitinib was initiated. After 1 year and 4 months, the PET-computed tomography scan showed a complete radiologic response.
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Affiliation(s)
- Miguel Nogueira
- Hospital Pedro Hispano, Radiology Department. Porto, Portugal
| | | | | | - João Pinto
- Hospital Pedro Hispano, Pathology Department. Porto, Portugal
| | - Jorge Machado
- Hospital Pedro Hispano, Radiology Department. Porto, Portugal
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Murakami Y, Shimura T, Okada R, Kofunato Y, Ishigame T, Yashima R, Nakano K, Suzuki S, Takenoshita S. Pancreatic metastasis of papillary thyroid carcinoma preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report with review of literatures. Clin J Gastroenterol 2018; 11:521-529. [PMID: 29948817 DOI: 10.1007/s12328-018-0875-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
Pancreatic metastatic tumors from thyroid carcinoma are extremely rare. We report a case of an 80-year-old female with a pancreatic metastatic tumor derived from papillary thyroid carcinoma which was initially resected 158 months prior to detection of the metastatic pancreatic tumor. The patient has encountered cervical lymph-node metastasis on three occasions following the initial operation. Metastatic pancreatic lesions and cervical lymph nodes were first detected using 18-fluorodeoxyglucose positron-emission tomography/computed tomography, and she was preoperatively diagnosed using endoscopic ultrasound-guided fine-needle aspiration biopsy. A coin lesion, 10 mm in size, was detected in the left lung by chest computed tomography with no abnormal uptake in 18-fluorodeoxyglucose positron-emission tomography/computed tomography. Distal pancreatectomy and cervical lymph-node dissection were performed. Adjuvant chemotherapy with weekly paclitaxel was administered because anaplastic transformation had been detected in one of the cervical lymph nodes. The patient eventually died from multiple lung metastases 11 months after removing the metastatic pancreatic lesion. We reported a rare case of a pancreatic metastatic tumor from thyroid carcinoma, and found that 18-fluorodeoxyglucose positron-emission tomography/computed tomography and endoscopic ultrasound-guided fine-needle aspiration biopsy are useful for preoperatively diagnosing tumors.
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Affiliation(s)
- Yuko Murakami
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tatsuo Shimura
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Ryo Okada
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuhide Kofunato
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Teruhide Ishigame
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Rei Yashima
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiichi Nakano
- Department of Thyroid and Endocrinology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiichi Takenoshita
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Choi TW, Lee JM, Kim JH, Yu MH, Han JK, Choi BI. Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions. Korean J Radiol 2016; 17:509-21. [PMID: 27390542 PMCID: PMC4936173 DOI: 10.3348/kjr.2016.17.4.509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 04/07/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs). MATERIALS AND METHODS 193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis. RESULTS The sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454). CONCLUSION MRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Kang TW, Kim SH, Lee J, Kim AY, Jang KM, Choi D, Kim MJ. Differentiation between pancreatic metastases from renal cell carcinoma and hypervascular neuroendocrine tumour: Use of relative percentage washout value and its clinical implication. Eur J Radiol 2015; 84:2089-96. [DOI: 10.1016/j.ejrad.2015.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/01/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023]
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Sandrasegaran K, Tomasian A, Elsayes KM, Nageswaran H, Shaaban A, Shanbhogue A, Menias CO. Hematologic malignancies of the pancreas. ACTA ACUST UNITED AC 2015; 40:411-23. [PMID: 25120155 DOI: 10.1007/s00261-014-0217-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematologic malignancies are relatively uncommon neoplasms of abdominal soft tissue. This article discusses the clinical and imaging features of pancreatic lymphoma, pancreatic extraosseous multiple myeloma, granulocytic sarcoma (chloroma), posttransplant lymphoproliferative disorder, and Castleman disease. The combination of imaging findings and the appropriate clinical presentation should allow the radiologist to raise a provisional diagnosis of hematologic malignancy.
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Affiliation(s)
- Kumar Sandrasegaran
- Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA,
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Hu S, Zhang J, Zuo C, Cheng C, Liu Q, Sun G. (18)F-FDG-PET/CT findings in pancreatic metastasis. LA RADIOLOGIA MEDICA 2015; 120:887-898. [PMID: 25795439 DOI: 10.1007/s11547-014-0473-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/14/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to evaluate the fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings and pattern of FDG uptake in pancreatic metastases. MATERIALS AND METHODS A total of 19 consecutive patients (26 lesions) with histologically or clinically confirmed pancreatic metastases who had undergone (18)F-FDG-PET/CT were enrolled in this retrospective study. Among the 19 patients, 14 patients underwent abdominal contrast-enhanced CT (ceCT). The location, size and FDG uptake patterns of the pancreatic lesions were recorded. Metabolic activity by means of maximum standardised uptake value (SUVmax) was measured by drawing regions of interest at the site of pancreatic lesions. Twenty pancreatic cancer patients were included in this study as comparative data analysis. The difference of SUVmax between pancreatic metastases and primary pancreatic cancer were compared using the Mann-Whitney U test. P < 0.05 was considered significant. RESULTS Three different patterns of FDG uptake could be distinguished in the pancreatic metastatic lesions, including focal nodule or mass, multiple foci and segmental lesion with high FDG uptake. The average SUVmax in pancreatic metastases was 7.8 ± 6.9 versus 7.4 ± 3.9 in primary pancreatic cancer (P = 0.987 > 0.05). Four intrapancreatic isodense nodules in three patients were undetected on ceCT. CONCLUSION The described patterns of FDG uptake findings may be helpful for a better characterisation of pancreatic metastases although semiquantitative analysis using SUVmax could not be used as a criterion for differentiating pancreatic metastases from primary pancreatic cancer. FDG-PET/CT has also an advantage in detecting unsuspected pancreatic metastases which cannot be detected by ceCT imaging. Thus, it is a useful adjunct to the described features on CT.
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Affiliation(s)
- Shengping Hu
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China.
| | - Jian Zhang
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China.
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China.
| | - Chao Cheng
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China.
| | - Qinghua Liu
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China.
| | - Gaofeng Sun
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China.
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Smith AL, Odronic SI, Springer BS, Reynolds JP. Solid tumor metastases to the pancreas diagnosed by FNA: A single-institution experience and review of the literature. Cancer Cytopathol 2015; 123:347-55. [PMID: 25828394 DOI: 10.1002/cncy.21541] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/11/2015] [Accepted: 03/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pancreatic fine-needle aspiration (FNA) is useful for diagnosing pancreatic masses. This article describes the experience of a single institution with metastases to the pancreas sampled by FNA and provides a review of the literature. METHODS Medical records were retrospectively searched for pancreatic FNA that showed metastatic disease. Data were gathered for the tumor size, focality, and time period between the primary tumor and the metastasis. A literature search using PubMed was performed. RESULTS Pancreatic FNA was performed 2327 times in 14 years at the authors' institution. Twenty-two cases showed metastatic disease. The average size of the metastatic lesions in their greatest dimension was 3.7 cm (range, 1.5-6.5 cm). The majority of the tumors were unifocal (16 of 22 or 73%). A rapid onsite adequacy evaluation was performed for 13 patients (4 were diagnostic of metastasis, 3 were positive for malignant cells, 6 were atypical, and none were negative). There were 14 renal cell carcinomas, 2 colonic adenocarcinomas, 1 urothelial carcinoma, 1 non-small cell lung carcinoma, 1 ovarian serous carcinoma, 1 prostatic adenocarcinoma, 1 papillary thyroid carcinoma, and 1 mesenchymal chondrosarcoma. The median time between the diagnosis of the primary tumor and the initial pancreatic metastasis was 9 years (range, concurrent diagnosis to 21 years). A literature review yielded 12 case series with a variety of metastases to the pancreas diagnosed by FNA and surgical pathology specimens. CONCLUSIONS In agreement with prior series, the most common metastasis to the pancreas was renal cell carcinoma. A variety of other primary malignancies were also documented in this study and in the literature. Also, this article reports the first case of metastatic mesenchymal chondrosarcoma to the pancreas diagnosed by FNA.
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Affiliation(s)
- Amber L Smith
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shelley I Odronic
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jordan P Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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15
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Hoshino Y, Shinozaki H, Kimura Y, Masugi Y, Ito H, Terauchi T, Kimata M, Furukawa J, Kobayashi K, Ogata Y. Pancreatic metastases from renal cell carcinoma: a case report and literature review of the clinical and radiological characteristics. World J Surg Oncol 2013; 11:289. [PMID: 24209713 PMCID: PMC3835140 DOI: 10.1186/1477-7819-11-289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/25/2013] [Indexed: 01/02/2023] Open
Abstract
Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma. We report the case of a 63-year-old woman, who presented with a pancreatic tumor detected during her annual health examination. She had undergone left nephrectomy 13 years previously for renal cell carcinoma. Computed tomography (CT) revealed two tumors in the head and body of the pancreas, a hypervascular tumor and a hypovascular tumor with an enhanced rim, respectively. She underwent pylorus-preserving pancreaticoduodenectomy, and metastatic pancreatic tumors arising from the kidney with clustered clear cell carcinoma immunohistochemically positive for CD10 were diagnosed. This report presents the different enhancement features of different lesions on CT scans. Because the enhancement features of lesions have been reported to vary according to the size of the metastatic tumor, a knowledge of the history of renal cell carcinoma is crucial for diagnosis.
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Affiliation(s)
- Yoshinori Hoshino
- Department of Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya 321-0974, Japan.
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Abstract
Metastases to the pancreas are rare; nevertheless, early detection allows for appropriate treatment and improved outcomes for metastatic disease. Computed tomography plays a pivotal role in characterizing these tumors, as demonstrated in this pictorial review. Given significant differences in prognosis and treatment, it is crucial to differentiate primary and secondary pancreatic lesions; however, this may not be possible based on imaging features alone.
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Mortelé KJ. Cystic Pancreatic Neoplasms: Imaging Features and Management Strategy. Semin Roentgenol 2013; 48:253-63. [DOI: 10.1053/j.ro.2013.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience. Pancreas 2013; 42:516-23. [PMID: 23211369 DOI: 10.1097/mpa.0b013e31826c276d] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited. METHODS This is a retrospective review of 23 patients referred to a tertiary referral center for further evaluation of suspected pancreatic metastases. Main outcome measures were diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in evaluation of metastatic lesions to the pancreas. RESULTS Of 644 patients, 23 (3.6%) undergoing EUS of the pancreas were diagnosed to have metastatic disease to the pancreas based on clinical, radiological, and cytological results. Mean (SD) age was 64.3 (11.7) years. Of the 23 patients, 18 (78.3%) were asymptomatic. Mean (SD) size of lesion on EUS was 39.1 (19.9) mm. A diagnosis of malignant lesion was made in 21 of 23 cases, with a diagnostic accuracy of 91.3%. CONCLUSIONS Metastatic lesions to the pancreas present as incidental, solitary mass lesions on staging or surveillance imaging. Endoscopic ultrasonography-guided fine-needle aspiration is an important tool in the characterization and further differentiation of metastatic lesions to the pancreas from primary pancreatic cancer.
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20
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Reid MD, Bagci P, Adsay NV. Histopathologic assessment of pancreatic cancer: Does one size fit all? J Surg Oncol 2012; 107:67-77. [DOI: 10.1002/jso.23194] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/21/2012] [Indexed: 01/04/2023]
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Triantopoulou C, Kolliakou E, Karoumpalis I, Yarmenitis S, Dervenis C. Metastatic disease to the pancreas: an imaging challenge. Insights Imaging 2012; 3:165-72. [PMID: 22696042 PMCID: PMC3314732 DOI: 10.1007/s13244-011-0144-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 10/19/2011] [Accepted: 11/23/2011] [Indexed: 12/15/2022] Open
Abstract
Metastatic lesions of the pancreas are uncommon, accounting for approximately 2% of pancreatic malignancies. Many tumours involve the pancreas secondarily and may manifest with different clinical and imaging characteristics. Although many patients have widespread disease, isolated metastases can be found. Surgical management is associated with improved survival in these cases. The experience of the pancreatic surgery unit and imaging department of our hospital in many patients presenting with pancreatic metastases is presented, and a review of the recent literature is undertaken. Main Messages • The early recognition of secondary pancreatic tumours on US, CT and MRI is extremely important. • Pancreatic metastases may mimic primary pancreatic adenocarcinoma or induce acute pancreatitis. • Most pancreatic metastases are discovered on a CT examination performed for follow-up.
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Affiliation(s)
- Charikleia Triantopoulou
- Radiology Department, Konstantopouleio General Hospital, 3-5, Agias Olgas Street, N. Ionia, 14233, Athens, Greece,
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Abstract
The vast array of possible histologies for a given pancreatic mass makes the specific diagnosis of a solid pancreatic mass in an individual patient challenging. This article discusses and reviews the imaging findings of those entities that are likely to be encountered in clinical practice, specifically pancreatic endocrine tumors, solid pseudopapillary tumor, secondary pancreatic masses, and heterotopic spleen.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, Room HCC232, New York, NY 10016, USA.
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23
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Abstract
Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article (1) reviews the imaging features of the common cystic pancreatic lesions, including serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor, and including the less common lesions such as cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas; and (2) provides comprehensive algorithms on how to manage the individual lesions, with recommendations on when to reimage patients.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Biopsy, Fine-Needle
- Cystadenocarcinoma/diagnosis
- Cystadenocarcinoma/pathology
- Cystadenocarcinoma/surgery
- Cystadenoma/diagnosis
- Cystadenoma/pathology
- Cystadenoma/surgery
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/pathology
- Cystadenoma, Serous/surgery
- Diagnosis, Differential
- Female
- Humans
- Magnetic Resonance Imaging/methods
- Middle Aged
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreas/diagnostic imaging
- Pancreas/pathology
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Tomography, X-Ray Computed/methods
- Ultrasonography
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Affiliation(s)
- Catherine E Dewhurst
- Division of Abdominal Imaging and MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
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24
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Ballarin R, Spaggiari M, Cautero N, De Ruvo N, Montalti R, Longo C, Pecchi A, Giacobazzi P, De Marco G, D'Amico G, Gerunda GE, Di Benedetto F. Pancreatic metastases from renal cell carcinoma: the state of the art. World J Gastroenterol 2011; 17:4747-56. [PMID: 22147975 PMCID: PMC3229623 DOI: 10.3748/wjg.v17.i43.4747] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023] Open
Abstract
Pancreatic metastases are rare, with a reported incidence varying from 1.6% to 11% in autopsy studies of patients with advanced malignancy. In clinical series, the frequency of pancreatic metastases ranges from 2% to 5% of all pancreatic malignant tumors. However, the pancreas is an elective site for metastases from carcinoma of the kidney and this peculiarity has been reported by several studies. The epidemiology, clinical presentation, and treatment of pancreatic metastases from renal cell carcinoma are known from single-institution case reports and literature reviews. There is currently very limited experience with the surgical resection of isolated pancreatic metastasis, and the role of surgery in the management of these patients has not been clearly defined. In fact, for many years pancreatic resections were associated with high rates of morbidity and mortality, and metastatic disease to the pancreas was considered to be a terminal-stage condition. More recently, a significant reduction in the operative risk following major pancreatic surgery has been demonstrated, thus extending the indication for these operations to patients with metastatic disease.
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25
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Angelelli G, Mancini M, Pignataro P, Pedote P, Scardapane A. Multidetector computed tomography in the study of pancreatic metastases. Radiol Med 2011; 117:369-77. [PMID: 22020429 DOI: 10.1007/s11547-011-0736-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/31/2011] [Indexed: 01/02/2023]
Abstract
PURPOSE The aim of this study was to explore the diagnostic performance of multidetector computed tomography (MDCT) in characterising pancreatic metastases. MATERIALS AND METHODS CT examinations of 17 patients affected by pancreatic metastases were retrospectively reviewed. The primary malignancy was renal cell carcinoma (RCC) in eight cases, uterine leiomyosarcoma in two, lung carcinoma in four and breast carcinoma in three. CT images were assessed for lesion number, size and morphology. RESULTS Pancreatic lesions were solitary in seven cases and multiple in ten. Lesion size ranged between 8 and 40 mm. Metastases from RCC were hyperattenuating in the arterial phase, metastases from breast cancer and lung cancer were hypoattenuating and metastases from uterine leiomyosarcoma were inhomogeneous. Precise lesion characterisation was obtained by using CT examination in 12 cases. In the remaining five patients, all with solitary metastases from RCC, a precise diagnosis was not possible because the lesions could not be differentiated from a neuroendocrine tumour. CONCLUSIONS MDCT allowed pancreatic metastases characterisation in 70.5% of cases. The lesions were the manifestation of widely disseminated neoplastic disease, with the exception of metastases from RCC, which were exclusively located in the pancreas.
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Affiliation(s)
- G Angelelli
- DiMIMP, Sezione di Diagnostica per Immagini, Università degli Studi di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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26
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Tan CH, Tamm EP, Marcal L, Balachandran A, Charnsangavej C, Vikram R, Bhosale P. Imaging features of hematogenous metastases to the pancreas: pictorial essay. Cancer Imaging 2011; 11:9-15. [PMID: 21367687 PMCID: PMC3080124 DOI: 10.1102/1470-7330.2011.0002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This pictorial essay illustrates the imaging appearances of a wide variety of metastases to the pancreas as seen on computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT. Key clinical and radiologic features (lesion distribution, non-contrast imaging appearance, enhancement pattern and pattern of spread) that may aid differentiation of primary from solitary secondary pancreatic malignancies are discussed.
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27
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Perez-Johnston R, Lenhart DK, Sahani DV. CT Angiography of the Hepatic and Pancreatic Circulation. Radiol Clin North Am 2010; 48:311-30, viii. [DOI: 10.1016/j.rcl.2010.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Hwang CY, Lee SS, Song TJ, Moon SH, Lee D, Park DH, Seo DW, Lee SK, Kim MH. Endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of pancreatic and peripancreatic lesions: a single center experience in Korea. Gut Liver 2009; 3:116-21. [PMID: 20431733 PMCID: PMC2852702 DOI: 10.5009/gnl.2009.3.2.116] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/26/2009] [Indexed: 12/26/2022] Open
Abstract
Background/Aims Although endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has been introduced and its use has been increasing in Korea, there have not been many reports about its performance. The aim of this study was to assess the utility of EUS-FNA without on-site cytopathologist in establishing the diagnosis of solid pancreatic and peripancreatic masses from a single institution in Korea. Methods Medical records of 139 patients who underwent EUS-FNA for pancreatic and peripancreatic solid mass in the year 2007, were retrospectively reviewed. By comparing cytopathologic diagnosis of FNA with final diagnosis, sensitivity, specificity, and accuracy were determined, and factors influencing the accuracy as well as complications were analyzed. Results One hundred twenty out of 139 cases had final diagnosis of malignancy. Sensitivity, specificity, and accuracy of EUS-FNA were 82%, 89%, and 83%, respectively, and positive and negative predictive values were 100% and 46%, respectively. As for factors influencing the accuracy of FNA, lesion size was marginally significant (p-value 0.08) by multivariate analysis. Conclusions EUS-FNA performed without on-site cytopathologist was found to be accurate and safe, and thus EUS-FNA should be a part of the standard management algorithm for pancreatic and peripancreatic mass.
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Affiliation(s)
- Chang Yun Hwang
- Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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29
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Sato M, Okumura T, Kaito K, Kiyoshima M, Asato Y, Uchiumi K, Iijima H, Hashimoto I, Kaburagi T, Amemiya R. Usefulness of FDG-PET/CT in the detection of pancreatic metastases from lung cancer. Ann Nucl Med 2009; 23:49-57. [PMID: 19205838 DOI: 10.1007/s12149-008-0205-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 08/12/2008] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of this study was to assess the ability to detect pancreatic metastasis of lung cancer and to clarify the degree of fluorodeoxyglucose (FDG) accumulation and computed tomography (CT) characteristics of pancreatic metastasis from lung cancer. METHODS A total of 573 patients (415 men and 158 women) with lung cancer were retrospectively evaluated. All patients underwent FDG-positron emission tomography (PET)/CT with contrast-enhanced CT for first=stage (313 patients; initial study group) or follow-up study (260 patients; follow-up study group). A lesion was regarded as positive for metastasis on the basis of visual judgment of the degree of increased metabolism by two experienced and independent interpreters, supported by semiquantitative evaluation on the basis of calculation of the maximum standardized uptake value (SUV(max)). RESULTS Abnormal accumulations in the pancreas were detected in 5 of 313 patients (1.60%) in the initial study group, and 6 of 260 patients (2.31%) in the follow-up study group. Seven of these patients had adenocarcinoma, three had small cell carcinoma, and the rest had large cell endocrine carcinoma. Tumor sizes (longitudinal diameter), measured by CT, of these 11 patients ranged from 6 mm to 52 mm (mean +/- SD 8.3 mm +/- 11.9 mm), and SUV(max) for 1 h ranged from 3.37 to 11.1 (mean +/- SD 6.12 +/- 2.43). Three of these pancreatic lesions were difficult to determine by routine transaxial images, and detection was obvious only by thin-slice images or multiplanar reconstruction images. Contrast-enhanced CT showed gradual fill-in from the peripheral portion to the center. In addition, 10 of 11 cases did not show main pancreatic duct dilatation even if the tumor size was large. CONCLUSIONS Metastases to the pancreas in lung cancer patients are not so rare and radiologists first have an important role to detect the pancreatic mass and then suggest to metastasis as the likely diagnosis. For this purpose, FDG-PET/CT has an advantage in depicting unsuspected pancreatic metastasis from lung cancer, particularly that which is not detected by CT alone.
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Affiliation(s)
- Motohiro Sato
- Department of Radiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan.
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30
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Sidden CR, Mortele KJ. Cystic tumors of the pancreas: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 2008; 28:339-56. [PMID: 17970551 DOI: 10.1053/j.sult.2007.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article aims to review the histopathologic and imaging findings of the relatively common lesions (serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor) and uncommon lesions (cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas) in this group.
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Affiliation(s)
- Christopher R Sidden
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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31
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Abstract
Neuroendocrine tumors may arise from a wide range of organs and may occur in various locations in the body. They include carcinoid tumors, paragangliomas (pheochromocytomas), medullary thyroid carcinomas, and islet cell tumors of the pancreas. In this article the authors focus on the more common tumors with origins primarily in the abdomen, namely carcinoid, paraganglioma, and pancreatic islet cell tumors. Imaging assists in delineating the sites and extent of disease, in preoperative planning for resection of the primary tumor and metastatic disease, and in follow-up. Discussion is restricted to the main imaging modalities used in these tumors: cross-sectional imaging, namely CT and MRI, and nuclear medicine studies.
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Affiliation(s)
- Eric P Tamm
- Department of Radiology, Unit 1264, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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Eidt S, Jergas M, Schmidt R, Siedek M. Metastasis to the pancreas--an indication for pancreatic resection? Langenbecks Arch Surg 2007; 392:539-42. [PMID: 17242893 DOI: 10.1007/s00423-007-0148-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 12/06/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Isolated metastatic involvement of the pancreas is very rare. To evaluate the possible benefit of surgery, we retrospectively analyzed patients that underwent pancreatic resection for metastases into the pancreas. PATIENTS/METHODS In 12 patients (8 men and 4 women), metastatic disease was treated by pancreatic resection (two total pancreatectomies, nine pylorus-sparing duodenopancreatectomies, and one left-side pancreatic resection) between 1993 and 2005 at our institution. Primary malignomas were renal cell carcinoma (RCC; n = 7), malignant melanoma (n = 4), and colon cancer (n = 1). All patients were followed-up until November 2006 or until death. RESULTS Complications requiring relaparotomy were found in two patients (retroperitoneal abscess and bile fistula), whereas one patient with pancreatic fistula could be treated by conservative measures. There was no perioperative mortality. Median survival time was 51 months (5-105 months). At the end of follow-up, seven patients were alive at 12 to 86 months, whereas five died between 5 and 105 months: four died of the disease, and one patient died of cardiac failure without evidence of recurrent cancer. CONCLUSION Patients with isolated pancreatic metastasis particularly of RCC benefit from surgery. Pancreatic resection may achieve long-term survival or good palliation in selected cases of other primaries as well.
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Affiliation(s)
- S Eidt
- Institute of Pathology, St. Elisabeth-Hospital Cologne, Werthmannstrasse 1, 50935, Cologne, Germany.
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Abstract
CT is the primary imaging modality of the pancreas. This article reviews the multidector CT technique and its current status in the diagnosis of various pancreatic diseases. Special emphasis is given to the impact of multidetector CT and postprocessing imaging techniques on the staging of pancreatic adenocarcinoma.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106-5056, USA.
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Guaraldi S, Sá E, Romano S, Carvalho ACP. O papel da ecoendoscopia no diagnóstico das neoplasias císticas primárias do pâncreas. Radiol Bras 2005. [DOI: 10.1590/s0100-39842005000600014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O diagnóstico das lesões císticas pancreáticas pelos métodos de imagem, especialmente as de pequeno tamanho, é cada vez mais freqüente. Em alguns casos, ele representa um dilema em relação à terapêutica, podendo ser pseudocistos inflamatórios, neoplasias primárias ou secundárias. Para a decisão terapêutica, é necessário definir se a neoplasia é benigna, maligna ou potencialmente maligna. Hoje, a ecoendoscopia é considerada o exame padrão-ouro para a investigação do pâncreas, fornecendo dados sobre a morfologia destas lesões e possibilitando, por meio da punção guiada em tempo real, a colheita de material para avaliação citológica e dos marcadores tumorais. Este procedimento é considerado seguro e eficiente e apresenta taxas de sensibilidade e especificidade altas e de morbidade e de complicações baixas. No diagnóstico das lesões mucinosas do pâncreas, os fatores preditivos mais significativos para o diagnóstico diferencial são a presença de septos, os nódulos murais e as alterações parenquimatosas, para o qual as taxas de sensibilidade, especificidade e grau de exatidão são, respectivamente, 94%, 85% e 88%. Os autores têm por objetivo revisar as principais neoplasias císticas primárias do pâncreas, enfatizando a aplicação da ecoendoscopia no diagnóstico definitivo dessas neoplasias.
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Affiliation(s)
- Simone Guaraldi
- UFRJ; Sociedade Brasileira de Endoscopia Digestiva - Sobed; Universidade do Mediterrâneo, França
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35
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Affiliation(s)
- Daniel Wolfson
- Department of Medicine, George Washington University Medical Center, Washington, DC, USA
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36
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Mesa H, Stelow EB, Stanley MW, Mallery S, Lai R, Bardales RH. Diagnosis of nonprimary pancreatic neoplasms by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2005; 31:313-8. [PMID: 15468134 DOI: 10.1002/dc.20142] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a proven modality for the diagnosis of primary pancreatic neoplasms. We describe our experience in diagnosing nonprimary pancreatic tumors by EUS-FNA. Cytology files were searched for all EUS-FNA of the pancreas for the period 2000-2002. All cases diagnosed as neoplasms were selected and those diagnosed as nonprimary pancreatic tumors were reviewed and analyzed. One hundred ninety-one of 468 cases were diagnosed as neoplasms. Eleven of these cases were diagnosed as nonprimary pancreatic tumors (2.4% of all diagnoses and 5.7% of all neoplasms). The diagnoses were supported by clinical history (n = 7), cytological findings (n = 11), cell block histology (n = 11), cell block immunohistochemistry (n = 6), and flow cytometry (n = 1). EUS-FNA is a safe and minimally invasive method for the diagnosis of nonprimary pancreatic neoplasms. Evaluation of clinical history, cytomorphology, and ancillary techniques, especially those applied to cell block material, are essential for accurate diagnoses.
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Affiliation(s)
- Hector Mesa
- Department of Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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37
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Yildirim Y, Sanci M. The feasibility and morbidity of distal pancreatectomy in extensive cytoreductive surgery for advanced epithelial ovarian cancer. Arch Gynecol Obstet 2004; 272:31-4. [PMID: 15480722 DOI: 10.1007/s00404-004-0657-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 06/08/2004] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Pancreatic metastasis of ovarian cancer is extremely rare and its therapeutic approach is not well documented. The objective of this study is to evaluate the feasibility and morbidity of pancreatic resection as a component of extensive cytoreductive surgery in epithelial ovarian cancer (EOC) patients with pancreas metastasis. METHODS Between December 2000 and February 2003, 98 EOC patients were treated with primary cytoreduction. Six (6.12%) of these patients had pancreatic tail metastasis and were operated on using the distal pancreatectomy. RESULTS Preoperatively, only 1 (16.7%) of the 6 patients had signs of metastasis to the pancreas on computed tomography (CT). Optimal cytoreduction (absent or < or =1 cm macroscopic residual tumor size) was achieved in all patients. In the early postoperative period, there were 4 patients (66.7%) with complications and no perioperative mortality. In 1 patient (16.7%), glucose intolerance as a late complication of pancreatic resection was detected. All patients received six cycles of platinum-based adjuvant chemotherapy following a cytoreductive operation. Mean follow-up was 27 months (range 9-36), and 3 (50%) patients are still alive at the end of the study period. The two-year survival rate was 66.7%. CONCLUSION In conclusion, if optimal cytoreduction is foreseen in advanced epithelial ovarian cancer with pancreatic tail metastasis, distal pancreatectomy should be kept in mind. This procedure has acceptable morbidity and seems to be an attribute for survival.
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Affiliation(s)
- Yusuf Yildirim
- Department of Gynecologic Oncology, SSK (Social Security Agency) Aegean Obstetrics and Gynecology Teaching Hospital, Izmir, Turkey.
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38
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Gritzmann N, Macheiner P, Hollerweger A, Hübner E. CT in the differentiation of pancreatic neoplasms--progress report. Dig Dis 2004; 22:6-17. [PMID: 15292690 DOI: 10.1159/000078730] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Today, computed tomography (CT) is the most commonly used imaging method in the assessment of pancreatic tumors. The sensitivity of CT in detection of pancreatic tumors is more than 90% when direct and indirect signs are used for diagnosis. However, the potential to differentiate exocrine (non-endocrine) tumors of the pancreas is limited. CT is used in these lesions to perform an adequate staging, especially for surgical purposes. The operative resectability, primarily in regard to vessels, lymph node metastasis and hepatic metastasis, has to be assessed. Keeping in mind the limitations of this macromorphological imaging procedure, CT has the best reproducibility and overall accuracy of all imaging methods. Using multislice CT it is possible to perform non-axial reconstructions with high resolution. In functional endocrine tumors, multislice spiral CT will enhance the diagnostic capabilities, since the whole organ can be examined in thin slices, with high resolution during the rather short arterial phase of the contrast medium. Since some endocrine tumors are hypovascular, a scan during the portovenous phase is recommended too. The diagnosis of benign pancreatic tumors, like serous cystadenoma and pancreatic lipomas, is addressed. The most important pseudotumors of the pancreas are discussed.
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Affiliation(s)
- Norbert Gritzmann
- Department of Radiology and Nuclear Medicine, KH Barmherzige Brüder Salzburg, Austria.
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39
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[Unilocular macrocystic serous cystadenoma of the pancreas: a morphologic variant to be considered]. ANNALES DE CHIRURGIE 2003; 128:177-9. [PMID: 12821086 DOI: 10.1016/s0003-3944(03)00036-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serous cystadenoma of the pancreas is a benign cystic tumor, which radiological diagnosis is easy in its typical microcystic variant. The macrocystic variant is uncommon and raises diagnostic problems with other macrocystic lesions of the pancreas such as pseudocysts and mucinous cystadenomas. We report the case of a young woman with a unilocular macrocystic serous cystadenoma of the pancreas which was identified on pathologic examination of the surgical specimen, after unconclusive abdominal ultrasound and CT-scan. This case describes an unusual clinical presentation of this cystic tumor and emphasizes that the diagnosis of such an entity is still based on pathological examination after cyst removal.
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40
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Abstract
In this article, the radiological manifestations of a variety of uncommon tumors of the pancreas are illustrated, with emphasis placed on their appearance at helical CT. Islet cell tumors, because of their vascularity, typically present as masses that are hyperattenuating to the normal pancreas at dual-phase helical CT. Lymphomas appear as hypoattenuating focal lesions or can diffusely infiltrate the gland. Absence of biliary tree dilatation, despite the presence of a bulky tumor, or associated extensive retroperitoneal adenopathy should offer clues to the diagnosis. Pancreatic metastases are usually seen in patients with advanced cancers, although isolated metastases from renal cell carcinoma can occurs years after the original tumor; such patients may benefit from surgical resection. Finally, the appearance of some rare neoplasms of mesenchymal origin is discussed.
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Affiliation(s)
- Sheila Sheth
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 North Caroline Street, JHOC-3250, Baltimore, MD 21287, USA
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41
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Bachmeyer C, Alovor G, Chatelain D, Khuoy L, Turc Y, Danon O, Laurette F, Cazier A, N'Guyen V. Cystic metastasis of the pancreas indicating relapse of Merkel cell carcinoma. Pancreas 2002; 24:103-5. [PMID: 11741190 DOI: 10.1097/00006676-200201000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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42
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Scatarige JC, Horton KM, Sheth S, Fishman EK. Pancreatic parenchymal metastases: observations on helical CT. AJR Am J Roentgenol 2001; 176:695-9. [PMID: 11222207 DOI: 10.2214/ajr.176.3.1760695] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J C Scatarige
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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43
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Karlson BM, Ekbom A, Lindgren PG, Källskog V, Rastad J. Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis. Radiology 1999; 213:107-11. [PMID: 10540649 DOI: 10.1148/radiology.213.1.r99oc25107] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To elucidate the accuracy of abdominal ultrasonography (US) in the diagnosis of pancreatic tumors. MATERIALS AND METHODS In all patients referred for pancreatic US during 1988-1990, data on malignant disease and survival were analyzed by using the Swedish Death and Cancer Registries. Nine hundred nineteen patients were entered into the analysis. In 140 of them, a clinical diagnosis of tumor in the pancreatic area was confirmed within 1 year after US. These tumors were primary pancreatic tumors (n = 102), common bile duct and duodenal cancers (n = 17), and metastases in the pancreatic area (n = 21). RESULTS The sensitivity of US in the detection of all tumors in the pancreatic area was 88.6% (124 of 140 patients), which was similar to that for the detection of exocrine pancreatic cancer, 90% (79 of 88 patients). There were nine false-positive US examinations, for a specificity of 98.8% (770 of 779 patients). Systematic sampling of 94 investigations confirmed an association between US accuracy and presence of clinical symptoms of pancreatic cancer. Significant differences in the sensitivity (P < .05) and accuracy (P < .01) of diagnosis were observed between three experienced investigators. CONCLUSION Study results support the use of US as a first-line diagnostic examination in patients suspected of having pancreatic tumor. Dependency on the investigator's experience with US mandates continuous evaluation of its performance.
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Affiliation(s)
- B M Karlson
- Department of Surgery, University Hospital, Uppsala, Sweden.
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