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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2023; 15(6): 925-942
Published online Jun 15, 2023. doi: 10.4251/wjgo.v15.i6.925
Pancreatic cancer, autoimmune or chronic pancreatitis, beyond tissue diagnosis: Collateral imaging and clinical characteristics may differentiate them
Ana I Tornel-Avelar, Jose Antonio Velarde Ruiz-Velasco, Mario Pelaez-Luna
Ana I Tornel-Avelar, Jose Antonio Velarde Ruiz-Velasco, Department of Gastroenterology, Hospital Civil of Guadalajara “Fray Antonio Alcalde”, Guadalajara 44340, Jalisco, Mexico
Mario Pelaez-Luna, Research Division School of Medicine/Department of Gastroenterology, Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition “Salvador Zubiran”, Tlalpan 14000, Mexico City, Mexico
Author contributions: Tornel-Avelar AI and Velarde-Ruiz Velasco JA performed literature research and drafted the manuscript, and elaborated some tables and figures; Pelaez-Luna M designed the study, performed literature research, elaborated some figures, drafted the manuscript, performed critical review, and editing of final version; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: None of the authors has any financial relationship or conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mario Pelaez-Luna, MD, Associate Professor of Medicine, Research Division School of Medicine/Department of Gastroenterology, Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition “Salvador Zubiran”, 15 Vasco de Quiroga, Belisario Domínguez Sección XVI, Tlalpan 14000, Mexico City, Mexico. mariopl@prodigy.net.mx
Received: February 20, 2023
Peer-review started: February 20, 2023
First decision: April 2, 2023
Revised: April 21, 2023
Accepted: April 28, 2023
Article in press: April 28, 2023
Published online: June 15, 2023
Processing time: 114 Days and 10 Hours
Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related death. Often, the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses, such as autoimmune pancreatitis (AIP) and mass-forming chronic pancreatitis (MFCP), making its diagnosis challenging. Differentiating AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic implications. Current diagnostic criteria and tools allow the precise differentiation of benign from malignant masses; however, the diagnostic accuracy is imperfect. Major pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate diagnosis. It is not unusual that after a thorough diagnostic evaluation, the clinician is confronted with a pancreatic mass with uncertain diagnosis. In those cases, a re-evaluation must be entertained, preferably by an experienced multispecialty team including radiologists, pathologists, gastroenterologists, and surgeons, looking for disease-specific clinical, imaging, and histological hallmarks or collateral evidence that could favor a specific diagnosis. Our aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP, PDAC, and MFCP and to highlight those disease-specific clinical, radiological, serological, and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.

Keywords: Pancreas cancer; Chronic pancreatitis; Autoimmune pancreatitis; Pancreas mass; Endoscopic ultrasound; Diagnosis

Core Tip: This article describes the flaws and hurdles of current diagnostic tools as well as disease specific imaging, serological and histological characteristics that play a significant role in the differentiation of focal autoimmune pancreatitis, mass-forming chronic pancreatitis and pancreatic ductal adenocarcinoma.