Multidetector-row computed tomography (MDCT) is useful for the evaluation of malignant biliary obstruction because it allows faster scanning, which decreases motion and breathing artifacts, as well as thinner collimation. In addition, MDCT leads to improved 3-dimensional assessment of vascular structures and biliary tree. The purpose of this pictorial essay is to introduce scanning techniques and image acquisition methods for the evaluation of malignant biliary obstruction and to highlight the unique display of diagnostic information by multiplanar reformations of the biliary tract with MDCT.
Humans ; Imaging, Three-Dimensional ; Pancreas/*radiography ; Pancreatic Diseases/*radiography ; Pancreatic Neoplasms/*radiography ; Tomography, Spiral Computed/instrumentation/*methods

As the detection rate of pancreatic cystic neoplasms (PCN) increases,recommendations or guidelines for the diagnosis and treatment of PCN have been released from professional organizations.From the perspective of radiology,we compared seven guidelines in terms of general introduction,preoperative monitoring methods and strategies,stratification of risk factors,surgical indications,and postoperative follow-ups,aiming to provide references for the evaluation of images and the formulation of individualized approach for the treatment of PCN.
Humans ; Pancreatic Cyst/therapy* ; Pancreatic Neoplasms/therapy* ; Pregnenolone Carbonitrile ; Radiography ; Radiology

Acinar cystic transformation of the pancreas is also known as acinar cell cystadenoma (ACC), and this is an extremely rare benign lesion that was first described in April 2002. We report here on a case of a previously asymptomatic patient with pancreatic ACC and this was diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). To the best of our knowledge, there is no previous report concerning the CT or MRI features of ACC in the medical literature. We present here the CT, MRI and pathological findings of pancreatic ACC.
Cystadenoma/pathology/*radiography ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/pathology/*radiography

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Female ; Humans ; Male ; Mesenteric Veins/radiography ; Pancreas/abnormalities ; Pancreatic Diseases/*diagnosis/therapy ; Pancreatic Fistula/etiology ; Pancreatic Neoplasms/diagnosis/surgery ; Pancreaticoduodenectomy/adverse effects ; Portal Vein/radiography ; Splenic Vein/radiography ; Tomography, X-Ray Computed

Pancreatic tuberculosis is a rare clinical entity, presenting as malignancy mimicking pancreatic mass. Therefore, it represents a diagnostic challenge. To date, ten cases have been reported in Korea. I report an additional case and review all Korean reports about pancreatic tuberculosis. A 57-year-old woman presented with abdominal pain. Abdominal computed tomography (CT) revealed a 2.2x1.2 cm cystic mass in pancreatic body. She was followed for nine months, at which time a cystic mass was enlarged to 3.3x2.2 cm in size on the CT. An exploratory laparotomy was performed for the accurate diagnosis and to rule out the possibility of malignant change. Pathological examination of the resected specimen revealed chronic granulomatous inflammation with caseous necrosis and multinucleated giant cells, which was compatible with tuberculosis. Among the 11 cases of pancreatic tuberculosis, five cases were combined with pulmonary tuberculosis. The pancreatic tuberculosis frequently presented with multicystic pancreatic mass (81%) and the most common anatomic locations were the head (73%), tail (18%), and body (9%). Three cases were diagnosed by using US or EUS guided fine needle aspiration biopsy (FNAB), and all cases were medically cured without exploratory laparotomy. In summary, pancreatic tuberculosis, despite its rarity, should be considered for differential diagnosis of pancreatic cystic mass in endemic countries. Clinical suspicion and accurate diagnostic approach including FNAB of pancreatic tuberculosis are needed to avoid performing unnecessary laparotomy.
Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Pancreatic Diseases/*diagnosis/pathology/radiography ; Pancreatic Neoplasms/diagnosis ; Tomography, X-Ray Computed ; Tuberculosis/*diagnosis/pathology/radiography

The macrocystic variant of serous cystadenomas of the pancreas has only recently been described. We present a case of a 40 year-old female, who presented with vague indigestion. The cyst was unilocular, and was lined by simple cuboidal, ciliated serous type epithelium. Fine needle aspiration, immunohistochemical, light microscopic, and electron microscopic studies are discussed.
Biopsy, Needle ; Cystadenocarcinoma, Serous/*pathology/radiography ; Female ; Humans ; Middle Aged ; Pancreatic Neoplasms/*pathology/radiography ; Tomography, X-Ray Computed

Extragonadal yolk sac tumor (YST) is a relatively rare entity. We describe here the case of an extragonadal YST that occurred in the pancreas with hepatic metastasis in an adult woman. The contrast enhanced CT images of the abdomen revealed a heterogeneous, solitary mass occupying the pancreatic neck and body with slightly inhomogeneous contrast enhancement. Two low-density lesions in the liver were also displayed on the CT images. The patient underwent surgery and the diagnosis of YST was pathologically verified.
Contrast Media ; Endodermal Sinus Tumor/pathology/*radiography/surgery ; Female ; Humans ; Liver Neoplasms/*radiography/secondary/surgery ; Middle Aged ; Pancreatic Neoplasms/pathology/*radiography ; Tomography, X-Ray Computed/*methods

A solid-pseudopapillary tumor (SPT) of the pancreas is known as a low grade malignant tumor with a good prognosis; therefore, surgical intervention is necessary. A 14-year-old boy presented with a large pancreatic SPT and three hepatic metastases. The patient and his family refused surgery. Two serial follow-up CT scans over a period of 13 years demonstrated almost complete disappearance of the pancreatic tumor and three hepatic metastases without relevant treatment. Although there have been a few reports of spontaneous healing of SPT, there has been no report regarding spontaneous disappearance of SPT and distant metastasis. Herein, we report on the spontaneous regression of a large SPT and the disappearance of three hepatic metastases.
Adolescent ; Carcinoma, Papillary/radiography/*secondary ; Humans ; Liver Neoplasms/radiography/*secondary ; Male ; Pancreatic Neoplasms/*pathology/radiography ; Remission, Spontaneous ; Tomography, X-Ray Computed

Adult ; Female ; Humans ; Pancreatic Neoplasms ; diagnosis ; diagnostic imaging ; Radiography ; Tuberculosis, Lymph Node ; diagnosis ; diagnostic imaging

OBJECTIVEThis pictorial review aimed to summarize the most possible differential diagnosis of pancreatic islet cell tumor (PICT).

DATA SOURCESData used in this review were mainly from Medline and Pubmed in English. And all clinical images in this review were from Department of Radiology, Peking Union Medical College Hospital, Beijing, China.

STUDY SELECTIONCases of pancreatic cystadenoma, solid pseudo-papillary tumor of the pancreas, pancreatic metastasis, pancreatic adenocarcinoma, para-pancreatic neuroendocrine tumors, Castleman disease, gastrointestinal stromal tumor, splenic artery aneurysm and accessory spleen were selected in this pictorial review for differential diagnosis of PICT.

RESULTSCareful analysis of imaging features and correlation with the clinical manifestations may allow a more specific diagnosis. It is also important that the radiologist is familiar with the anatomic variants and disease entities which mimic pancreatic islet cell tumor in order to avoid an improper treatment protocol.

CONCLUSIONSMany congenital anatomic variants or other pancreatic and peri-pancreatic diseases may mimic MDCT appearance of pancreatic islet cell tumor. Radiological, clinical and pathological characteristics should be considered for the final diagnosis.