A 50-year-old Chinese man presented to the clinic with left hypochondrial pain, more than 10 kg of weight loss over a 3-month period, and a firm, large, ill-defined mass in the left upper quadrant. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a well-circumscribed exophytic pancreatic mass with features suggestive of acinar cell carcinoma (ACC). The patient underwent chemotherapy and radiotherapy, with no evidence of local recurrence detected at one-year follow-up. He remains under close surveillance by his oncologist. Treatment for ACC includes surgical resection with adjuvant radiotherapy. Better overall survival is seen in patients with surgically resectable ACC as compared to those with the more common ductal cell carcinoma.
Carcinoma, Acinar Cell ; diagnostic imaging ; pathology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Carcinoma ; diagnostic imaging ; secondary ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Pancreatic Neoplasms ; diagnostic imaging ; secondary ; Ultrasonography

To analyze the CT features of solid pseudopapillary tumor of pancreas (SPTP), and correlation with the pathological findings of the disease so as to improve the diagnostic abilities, the CT images and the clinical manifestations, we retrospectively analyzed the pathological materials of 23 cases with surgery and pathology proved SPTP. In the 23 patients, 21 cases were female (91.3%) and 2 were male (8.7%). The most common symptom was abdominal discomfort with dull pain in 12 patients (52.2%). Others included the pancreatic mass that was detected incidentally during physical examination in 9 patients (39.1%), nausea/vomiting in 2 patients (8.7%). And 1 case of female patients had 2 lesions. In the 24 tumors, 6 cases were located at the head (25.0%), 3 were at neck (12.5%), 8 cases were at body (33.3%), and 7 cases were at tail of pancreas respectively (29.2%). The long-axis diameter ranged from 2.1 cm to 20.1 cm (mean 6.4 cm). 9 tumors were mostly solid component (37.5%), 10 tumors were contained similar proportion of solid and cystic part (41.7%), and mainly cystic components in 5 tumors (20.8%). In 9 of the 23 patients, calcification was found in the tumor (39.1%). In 2 of the 23 patients, bleeding was seen in the mass (8.7%). The dilation of intrahepatic bile duct was found in 1 patient (8.7%). Liver metastasis was showed in one patient (8.7%). On post-contrast CT scan, solid parts demonstrated mild enhancement at the arterial phase. At the portal phase, solid parts were enhanced continuously in all cases, and the enhancement degrees were lower than normal pancreatic tissue. The cystic parts of all lesions showed no enhancement. Pseudo papillary structure, hemorrhage, necrosis, or cystic degeneration were found in all patients by histological study. In a word, SPTP has comparatively characteristic CT imaging features consistent with histological features, when combined with clinical manifestations, could be correctly diagnosed and differentially diagnosed.
Bile Ducts, Intrahepatic ; Calcinosis ; diagnostic imaging ; Female ; Humans ; Liver Neoplasms ; secondary ; Male ; Pancreas ; diagnostic imaging ; pathology ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the feasibility of using multi-slice helical computed tomography (MS-CT) to accurately distinguish serous cystadenomas from mucinous cystadenomas or cystadenocarcinomas of the pancreas and to determine their radiographic appearances that can be applied for differentiative diagnosis.

METHODSWe performed a single-blind retrospective analysis of CT images of 30 patients with pathologically proven primary cystic pancreatic neoplasms (12 cases of serous cystadenomas, 14 cases of mucinous cystadenomas, and 4 cases of mucinous cystadenocarcinomas) to reach a diagnosis of either serous cystadenoma or mucinous cystic tumor. CT features such as tumor location, septations, presence of calcification, features of cystic wall, papillary excrescences, and size of the largest cyst were recorded. Statistical analysis was performed to evaluate the efficacy of certain CT findings in the differentiation of serous cystadenomas and mucinous neoplasms.

RESULTSTotally 9 (75.0%) serous cystadenomas and 16 (88.9%) mucinous tumors were correctly diagnosed. Three serous cystadenomas were misdiagnosed as mucinous cystadenomas, while 2 mucinous neoplasms were misdiagnosed as serous cystadenomas. And 9 (75.0%) serous cystadenomas were located at the pancreatic head and neck areas, while 12 (66.7%) mucinous neoplasms were located at the pancreatic body and tail areas (P < 0.05). The presence of calcification, especially central calcification, had statistical significance in differentiating serous cystadenoma from mucinous neoplasms (P < 0.05). The size of the largest cyst over 2 cm was positive associated with mucinous neoplasms (P < 0.05).

CONCLUSIONCT characteristics between serous cystadenomas and mucinous neoplasms of the pancreas have distinct difference, which validates the values of CT in differentiating these tumors. However, atypical CT appearances may compromise its diagnostic accuracy.

Cystadenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; Cystadenoma, Mucinous ; diagnostic imaging ; pathology ; Cystadenoma, Serous ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Single-Blind Method ; Tomography, Spiral Computed

Pancreatic pseudocysts are the most common cystic lesions of the pancreas and may complicate acute pancreatitis, chronic pancreatitis, or pancreatic trauma. While the majority of acute pseudocysts resolve spontaneously, few may require drainage. On the other hand, pancreatic cystic tumors, which usually require extirpation, may disguise as pseudocysts. Hence, the distinction between the two entities is crucial for a successful outcome. We conducted this study to highlight the fundamental differences between pancreatic pseudocysts and cystic tumors so that relevant management plans can be devised. We reviewed the data of patients with pancreatic cystic lesions that underwent intervention between June 2007 and December 2010 in our hospital. We identified 9 patients (5 males and 4 females) with a median age of 40 years (range, 30-70 years). Five patients had pseudocysts, 2 had cystic tumors, and 2 had diseases of undetermined pathology. Pancreatic pseudocysts were treated by pseudocystogastrostomy in 2 cases and percutaneous drainage in 3 cases. One case recurred after percutaneous drainage and required pseudocystogastrostomy. The true pancreatic cysts were serous cystadenoma, which was treated by distal pancreatectomy, and mucinous cystadenocarcinoma, which was initially treated by drainage, like a pseudocyst, and then by distal pancreatectomy when its true nature was revealed. We conclude that every effort should be exerted to distinguish between pancreatic pseudocysts and cystic tumors of the pancreas to avoid the serious misjudgement of draining rather than extirpating a pancreatic cystic tumor. Additionally, percutaneous drainage of a pancreatic pseudocyst is a useful adjunct that may substitute for surgical drainage.
Adult ; Aged ; Cystadenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; surgery ; Cystadenoma, Serous ; diagnostic imaging ; pathology ; surgery ; Diagnostic Errors ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Cyst ; diagnostic imaging ; pathology ; surgery ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Pancreatic Pseudocyst ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo study and compare the accuracy and sensitivity of endoscopic ultrasonography (EUS) and CT scaning in determination of preoperative stage and vascular invasion by pancreatic and ampullary cancers.

METHODSFourty-two pancreatic cancer patients and 18 ampullary cancer patients were studied. With patients prepared according to conventional endoscopy, Olympus EUM-30 scope 1 set with a side view and 360 degrees rotate and switchable scanning probe [ultrasound frequency (7.5/12 MHz)], was introduced to the descending duodenum through the esophagus. Gas within the duodenum and stomach was aspirated. Then, in order to to facilitate ultrasound transmission, 200 ml deaerated water was injected into the duodenum and 500 ml into the stomach to distend it. The structures of each part of pancreatic head and ampullary together with surrounding vessels were scanned. Then, the scope was withdrawn to the gastric antrum, body and fundus gradually, while the pancreatic body and tail were scanned.

RESULTSBetween Apr. 1996 to May 2004, a total of 42 pancreatic cancer patients and 18 ampullary cancer patients were examined by EUS. Meanwhile, all these 58 patients received preoperative CT scaning. The results of stage and vascular invasion determined by EUS in this series were as following; pancreatic cancer group (n = 42): accuracy in T2-4 stage was 100.0% (5/5), 75.0% (9/12) and 48.0% (12/25), respectively; ampullary cancer group (n = 18): T1-4 stage was 75.0% (3/4), 66.7% (2/3), 75.0% (6/8) and 33.3% (1/3), respectively; the accuracy in N stage: P-group: 80.0% in N1 (4/5), 90.0% in N0 (9/10); A-group: 50.0% in N1 (3/6), 91.0% in N0 (10/11). The sensitivity, specificity of vascular invasion, resectability and unresectablilty determined by EUS and CT as compared with surgical findings during operation was 52.9% (9/17), 93.1% (27/29), 77.1% (27/35) and 81.8% (9/11) for EUS (n = 60), respectively; and 11.8% (2/17), 92.6% (25/27), 62.5% (25/40) and 50.0% (2/4) for CT (n = 58), respectively.

CONCLUSIONEndoscopic ultrosonography being one of the best image examinations to determine the stage and vascular invasion for pancreatic and ampullary cancer paitients is able to detect small pancreatic or ampullary cancer less than 2.0 cm in diameter due to its high resolution; but can not detect the secondary multiple distal metastases such as spread into the liver, peritonium or hepatoduodenal ligament, etc. due to its ultrasound depth limitation.

Ampulla of Vater ; diagnostic imaging ; pathology ; Common Bile Duct Neoplasms ; diagnostic imaging ; pathology ; surgery ; Endosonography ; Female ; Humans ; Lymphatic Metastasis ; Male ; Mesenteric Veins ; diagnostic imaging ; pathology ; Neoplasm Invasiveness ; Neoplasm Staging ; Pancreas ; diagnostic imaging ; pathology ; Pancreatectomy ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Portal Vein ; diagnostic imaging ; pathology ; Preoperative Care ; Tomography, X-Ray Computed ; Vascular Neoplasms ; diagnostic imaging ; pathology

INTRODUCTIONAccurate staging of patients with pancreatic cancer is important to avoid unnecessary operations. The aim of this study was to prospectively assess the impact of magnetic resonance (MR) imaging on preoperative staging of liver in patients with findings of resectable pancreatic cancer on computed tomography (CT).

METHODSAll patients who presented to a tertiary referral centre with pancreatic cancer between April 2012 and December 2013 were included in the study. Patients with findings of resectable disease on CT underwent further liver diffusion-weighted MR imaging, using a hepatocyte-specific contrast agent.

RESULTSA total of 583 patients with pancreatic cancer were referred. 69 (11.8%) had resectable disease on CT. Of these 69 patients, 16 (23.2%) had liver metastases on MR imaging, while 6 (8.7%) had indeterminate lesions. Of the 16 patients with positive MR imaging findings of liver metastases, 11 died of pancreatic cancer, with a mean survival time of nine months (95% confidence interval [CI] 5.22-14.05). The mean survival time of the 47 patients with negative MR imaging findings was 16 months (95% CI 14.33-18.10; p = 0.001). Subsequently, 22 of these patients underwent surgery, and only 1 (4.5%) patient was found to have liver metastasis at surgery.

CONCLUSIONThe results of the present study indicate that MR imaging improves the staging of disease in patients with resectable pancreatic cancer.

Adult ; Aged ; Female ; Humans ; Liver ; diagnostic imaging ; pathology ; Liver Neoplasms ; diagnostic imaging ; pathology ; secondary ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; Prospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Unnecessary Procedures

OBJECTIVETo create the clinical degree of the superior mesenteric vein (SMV) involvement in pancreas uncinate process carcinoma (PUPC) and its clinical significance to be discussed.

METHODSAccording to the contiguous relationship between the SMV and the PUPC, the clinical degree of SMV involvement in PUPC are as followings four grades, 1 grade, the grade of clear boundary. 2 grade, the grade of fuzzy boundary. 3 grade, the grade of dissolved boundary. 4 grade, the grade of SMV infringed. The coherence between the type under the CT scan (Tx) and the type under the inoperative judgement (Sx) were analyzed with Kappa-test.

RESULTSThere is a significant difference between the grade of SMV involvement and the surgery. The resection rate is 100% in 1st grade, 97.4% in 2nd grade, 65.8% in 3rd grade and 21.7% in 4th grade. There is coherent in the degree judgement between the CT scan and the inoperative inspection (U = 15.96, P < 0.01).

CONCLUSIONSThere is clinical significance to establish the degree of SMV involvement in PUPC. It is helpful for clinician to accurately know its anatomic characteristic and decide more reasonable surgical strategy.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Mesenteric Veins ; diagnostic imaging ; pathology ; surgery ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Peritoneal Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo investigate the CT and MRI manifestatitions of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

METHODSBoth clinical and imaging data of 12 pathologically confirmed intraductal papillary mucinous neoplasm, of the pancreas were retrospectively analyzed.

RESULTSThe pancreatic IPMN can be classified into two types based on CT image: the branch duct IPMN (n=7) originated from the head and uncinate process of the pancreas. The tumor consisted of lobulated or clustered small cyst lesions with septa among them, the wall and septa can be enhanced; the combined IPMN (n=5) involved branch ducts of the uncinate process as well as the main pancreatic ducts with dilatation (diameter: 4-7 mm), one of these involved the branch ducts along the pancreatic body. The pancreatic IPMN was mainly found in elderly patient with a chief clinical symptoms of abdominal pain and/or pancreatitis.

CONCLUSIONThe intraductal papillary mucinous neoplasm of the pancreas enjoys specific features in CT and MRI image, which are helpful to the diagnosis.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal ; diagnosis ; diagnostic imaging ; Carcinoma, Papillary ; diagnosis ; diagnostic imaging ; Cystadenocarcinoma, Mucinous ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatic Ducts ; diagnostic imaging ; pathology ; Pancreatic Neoplasms ; diagnosis ; diagnostic imaging ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Gastrinoma has a low incidence, and the pancreas-originated gastrinoma is rare. Pancreatic gastrinoma patients with liver metastases have poor prognosis and short survival. Local treatment to reduce the tumor burden helps to improve symptoms and slows down tumor progression for patients with unresectable tumors. We report a case of pancreatic tail gastrinoma with unresectable liver metastases. The patient received a comprehensive minimally invasive interventional treatment, that is, chemoembolization and radiofrequency ablation for liver metastases, and percutaneous transplenic radiofrequency ablation combined with radioactive 125I seed implantation for pancreatic tail gastrinoma. The patient was followed up for more than 20 months, and showed no clear evidence of tumor recurrence. We explored the safety and feasibility of percutaneous transplenic radiofrequency ablation for unresectable pancreatic tail gastrinoma. This transplenic approach allow more indications for minimally invasive therapy and provides a new treatment option not only for patients with unresectable pancreatic tail tumor but also for patients refusing surgery.
Catheter Ablation ; Gastrinoma ; diagnostic imaging ; secondary ; surgery ; Humans ; Liver Neoplasms ; diagnostic imaging ; secondary ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multimodal Imaging ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Positron-Emission Tomography ; Tomography, X-Ray Computed