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20:09 CET
E³ 24E - Pancreatic adenocarcinoma mimickers
Abdominal Viscera Oncologic Imaging
Sunday, March 3, 12:30 - 13:30
Room: C
Type of session: E³ - The Beauty of Basic Knowledge: Pancreas
Topic: Abdominal Viscera, Oncologic Imaging
Moderator: A. Ba-Ssalamah (Vienna/AT)

A-1087
12:30
Autoimmune pancreatitis
R. Pozzi Mucelli; Verona/IT
Learning Objectives

1. To learn about autoimmune pancreatitis.
2. To understand imaging findings of pancreatic adenocarcinoma mimickers.
3. To appreciate differential diagnosis criteria with pancreatic adenocarcinoma.

Abstract

Autoimmune pancreatitis (AIP) represents a distinct form of chronic pancreatitis. Histologically, AIP is characterised by a dense lymphoplasmacytic infiltrate of mainly CD4+ T lymphocytes and immunoglobulin G4 plasma cells, located around the pancreatic ducts with mass-forming regions of fibrosis. AIP has been classified into focal or diffuse forms. The differential diagnosis between focal AIP and pancreatic adenocarcinoma represents a medical need since AIP responds to steroid therapy and surgery should be avoided. CT and MRI findings of AIP are characterised by an enlargement of the gland, either focal or diffuse. At CT the affected areas are isodense before contrast enhancement, hypodense (due to hypervascularity) in the arterial phase with the progressive increase in density in the venous and late phases following contrast administration. The involved areas appear hypointense on T1-weighted MR images, mild hyperintense on T2-weighted images with reduced diffusion at DWI. The lesion appears hypovascular during the arterial phase, with progressive enhancement and delayed retention of contrast in the venous and late phases. MRCP is able to assess the involvement of the pancreatic duct system and these features are important in the differential diagnosis with the pancreatic adenocarcinoma in which the main pancreatic duct is characterised by single short stenosis, with marked dilation of the upstream ductal system. In cases in which AIP involves the head of the pancreas, dilatation of the common bile duct and the intrahepatic ducts can be seen.

A-1088
13:00
Paraduodenal pancreatitis
G. Morana; Treviso/IT
Learning Objectives

1. To learn about autoimmune paraduodenal pancreatitis.
2. To understand imaging findings of paraduodenal pancreatitis.
3. To appreciate differential diagnosis criteria with pancreatic adenocarcinoma.

Abstract

Paraduodenal pancreatitis is a form of chronic pancreatitis involving the duodenal wall in the region of the minor papilla and is considered a distinct entity with peculiar pathological findings. The frequent presence of the so-called heterotopic pancreatic tissue in the duodenal wall may reflect the incomplete involution of the dorsal pancreas in this region and contribute to an obstruction of the outflow in this area. Histologically there is thickening and scarring of the duodenal wall that extends to the adjacent pancreatic tissue and/or cystic changes in the duodenal wall. Occasionally some of the cysts may have a diameter of several centimetres. The clinical profile of PP is middle-aged men, heavy drinkers and smokers with painful pancreatitis, associated with vomiting and weight loss due to duodenal stenosis and impaired motility. The most characteristic imaging finding at CT and MRI is a sheet-like mass between the head of the pancreas and the C-loop of the duodenum (the so-called groove). The mass is hypodense/hypointense to the pancreatic parenchyma. Contrast-enhanced dynamic images show a delayed and progressive enhancement in the late phase that reflects the fibrous nature of the tissue. Cystic lesions are well depicted in the groove or the duodenal wall, especially in T2-weighted images. In early stage MPD is normal; in advanced cases, pancreatic head or entire gland are involved, showing findings of chronic obstructive pancreatitis, with ductal dilatation. There is an absence of vascular encasement, with a leftward displacement of the gastroduodenal artery without obstruction.

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