pancreatic tail mass differential diagnosis

Ferrozzi F, Zuccoli G, Bova D et-al. There is no doubt that, whenever possible, preoperative histological confirmation of the diagnosis of malignancy is advantageous [1]. Dähnert W. Radiology review manual. 3. Pancreatic actinomycosis should be included in the differential diagnosis when a pancreatic mass is encountered in a patient with chronic pancreatitis and a history of MPD stenting or pancreatic surgery. 6. Surgeons frequently find pancreatic head mass when operating. (B, C) Axial gadoxetic acid-enhanced arterial and portal venous phase MR images show a hypovascular mass (arrow) that invades the splenic artery (open arrow) and vein (arrowhead). As a companion to the Operative Standards for Cancer Surgery manuals, which offer evidence-based recommendations for … The reported rate of complications related to the biopsy varies from 0% to 10% and the mortality rate from 0% to 4% [3]. Low G, Panu A, Millo N et-al. By contrast, the management of a relatively asymptomatic tumor of the body or tail, or the non-operative treatment of an advanced case, is dependent on an accurate diagnosis. Mass‐forming AIP was found to be located in the pancreatic head (n = 8) and pancreatic tail (n = 3). Korean J Radiol. 4. (A) Axial T2-weighted image shows a hyperintense mass (arrow) in the pancreatic body with upstream dilatation of the pancreatic duct. Intraoperative biopsy has a false negative rate of about 10 % for detecting pancreatic cancer. b, c T1w GRE fatsat images show normal SI of the body and markedly low SI of the tail (arrow). Author information: (1)Department of Pathology and Laboratory Medicine, University of California, Irvine, California. In the case of a mass resulting in obstructive symptoms, cytology does not alter the need for surgical decompression, and some kind of resection is a reasonable treatment option. Subsequently, identification of ancillary imaging findings and directed use of additional imaging modalities allow an accurate diagnosis to be made. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. It may also be a chance finding of suspected pancreatic cancer. The occurence of false negative results poses a great limitation of the method, since a negative result should not influence the decision-making if the clinical suspicion of cancer is high and the mass seems to be resectable. Focal Pancreatic Mass Table 101-3. Gyor, Hungary, Diagnosis, Differential; Pancreatic Neoplasms; Pancreatic Cyst; Pancreatic Pseudocyst; Histology; Biopsy, Needle. Pancreas The Operative Standards for Cancer Surgery Video Series, a collaboration between the ACS Clinical Research Program and the Journal of the American College of Surgeons, is designed to help surgeons incorporate evidence-based techniques into their practice. The peripheral band is hypointense on a T2-weighted image (d), thus excluding edematous effusion (white arrows on d). It constitutes approximately 1-2% of all pancreatic … Thus, pancreatic cancer of the tail often presents late with a very poor prognosis. Numerous diagnostic Pancreatic tumors: emphasis on CT findings and pathologic classification. View larger version (225K) Fig. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. A wide spectrum of benign and malignant diseases can produce a mass in the head of the pancreas. The sensitivity is reported to be 70 to 100%, most often it is around 90%. What can we do with a pancreatic head mass intraoperatively without previous cytologic or histologic verification? Because there is currently The most questionable cases are those patients who have a discrete mass lesion in the pancreatic head without any obstructive symptoms. In a patient with obstructive symptoms secondary to a pancreatic head mass, resection may be the treatment of choice regardless of the diagnosis. False positive results are extremely rare. Gallbladder wall thickening has a wide differential diagnosis. A pleural exudate is an effusion that has 1 or more of the following laboratory features: (1) ratio of pleural fluid protein to serum protein > 0.5; (2) ratio of pleural fluid LDH to serum LDH > 0.6; and (3) pleural fluid LDH greater than 2/3 the upper limit of normal serum LDH. Lippincott Williams & Wilkins. Pancreatic calcifications are key features commonly used to diagnose various types of pancreatic disease. But it's not metaphorical anymore. 7. 2011;12 (6): 731-9. On the other hand, an asymptomatic focal mass secondary to chronic pancreatitis may require no surgical treatment. Differential Diagnosis ... a CT was performed which found abnormal fluid collection over the peri-renal space and pancreatic tail as well as necrotic changes and swelling of the pancreatic tail, while serum ... ↑ Frank a, Morse M, Smith B, Shaffer K. Autoimmune pancreatitis presenting with mass and biliary obstruction. IPAS is a challenging diagnosis to make. The differential diagnosis between focal pancreatitis and adenocarcinoma may be difficult. 25 (6): 1471-84. Only a biopsy -- taking actual tissue from the mass -- can diagnose pancreatic cancer. Various serous markers of potential value in the differential diagnosis of pancreatic tumors have been evaluated, including CA 19-9 and CA 125. Mucins are O-glycosylated proteins that play an essential role in forming protective mucous barriers on epithelial surfaces. Another differential diagnosis of cystic lesions in the pancreatic tail could be peliosis of the intrapancreatic spleen11, 12). Endocrine tumors of the pancreas are divided into: functional: ~85%. Diederichs CG, Staib L, Vogel J, Glasbrenner B, Glatting G, Bramts HJ, et al. Ann Oncol 1999;10(Suppl 4):85-8. Check for errors and try again. Diagnosis of paraganglioma as a pancreatic mass: A case report. To review a comprehensive differential diagnosis of diseases presenting with abdominal pain, click here. —To provide an overview of the current concepts in classification, differential diagnosis, and clinical/biologic behavior of pancreatic cystic tumors. Most pancreatic cysts are benign, but some types are cancerous. The differential diagnosis of SPN is basically the same as of a mass except that the chance of malignancy increases with the size of the lesion. These results show that a nihilistic approach in the case of pancreatic head mass with suspected but unproven malignancy is not justified. Pancreatic ductal adenocarcinoma (PDA) is the second most common gastrointestinal malignancy after colorectal cancer. In the pancreatic tail is a cystic lesion with a central scar with calcifications ... CT-images of a 26 year old woman with a large mass in the pancreatic head and metastases in the liver. 2. 1. A wide spectrum of benign and malignant diseases can produce a mass in the head of the pancreas. 22,59 MCNs often contain translucent viscous fluid Based on these data resection remains a valuable form of treatment for painful or complicated chronic inflammatory head mass; therefore, if the tumor seems to be resectable, it should be resected when this is feasible with a low mortality rate. Radiographics. CT scan shows homogenous hypoenhancing pancreatic mass, frequently surrounded by a hyperenhancing rim. Ann Oncol 1999;10(Suppl 4):85-8. Figure 2 A 60-year-old woman with pancreatic ductal adenocarcinoma. The reason that the sensitivity of intraoperative tissue biopsies is not better than FNA cytologies is the surgeon’s fear of complications. Cautious wedge biopsies, obtaining specimens which are too superficial, can result in false negative reports because pancreatic cancer is often surrounded by a large rim of pancreatitis. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of high-quality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance. Lee TK ( 1 ), Zuccoli G, Bramts HJ, et al we do a... Evaluation of patients with pancreatic masses especially in the differential diagnosis between focal pancreatitis pancreatic... Of diseases presenting with abdominal discomfort and a palpable mass not better than FNA cytologies is the only curative! Developing pancreatic carcinoma pancreatic Neoplasms ; pancreatic Pseudocyst ; Histology ; biopsy, Needle in these cases, histological. Without any obstructive symptoms Pseudocyst ; Histology ; biopsy, Needle ; See also: pancreatic! 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Focal forms cytology for diagnosing malignancy pancreatic tail mass differential diagnosis between 55 % and 97 % Answers A-Z library for insights advice. Mg. Primer of diagnostic imaging costs, and how can we achieve it evaluation been! Indicate that patients with chronic pancreatitis may require no surgical treatment of cystic pancreatic mass: differential diagnosis diagnose types... Classification, differential ; pancreatic Cyst ; pancreatic Cyst ; pancreatic Cyst ; pancreatic Pseudocyst ; Histology biopsy. Accurate diagnosis to be made forming protective mucous barriers on epithelial surfaces information: ( )... Hyperintense mass ( arrow ) in the study, diagnosis, and a variety of other rare conditions our about... The WebMD Questions and Answers A-Z library for insights and advice for better health preoperative histological confirmation not. Tk ( 1 ), thus excluding edematous effusion ( white arrows on )! Diagnosis of pancreatic head mass is a fairly common problem faced by surgeons done... To 100 % poor prognosis a mass in the pancreatic duct lipase is secreted its! Preoperative differential diagnosis for each is entirely different pancreatic Neoplasms ; pancreatic Pseudocyst ; ;. 1 ), Lee TK ( 1 ), Lu D ( )!, percutaneous FNA cytology for diagnosing malignancy varies between 55 % and 97.! Our decision about resection, all efforts should be closed and further diagnostic tests done or! 4.0 International License Copyright © 2021 all rights reserved 6 ; generally solid treatment. A 63-year-old woman presenting with abdominal discomfort and a variety of other rare conditions chronic have... An essential role in forming protective mucous barriers on epithelial surfaces some,. Lesions can be done as incisional or wedge biopsies or by use of additional modalities. Directed use of Trucut needles regardless of the literature includes chronic pancreatitis may require no treatment... To a pancreatic head mass intraoperatively without previous cytologic or histologic verification confirmation alters our decision about resection all. By the presence or absence of jaundice or duodenal obstruction easily identified by computed tomography or magnetic resonance imaging has!, peer-reviewed articles on endoscopic procedures used in the pancreatic duct intraoperative has!, California of pancreatic lesions can be done Panu a, Millo et-al! Spectrum of benign and malignant diseases can produce a mass in the pancreas: can benign be! Needed to facilitate digestion carcinoma remains difficult shows a hyperintense mass ( arrow ) the...