Paraduodenal pancreatitis as a mimicker of pancreatic adenocarcinoma: MRI evaluation

Boninsegna, Enrico; Negrelli, Riccardo; Zamboni, Giulia; Tedesco, Giorgia; Manfredi, Riccardo; Mucelli, Roberto Pozzi

doi:10.1016/j.ejrad.2017.08.031

Cited by 7 publications

(14 citation statements)

References 26 publications

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“…The most suggestive signs of GP are signal hyperintensity in the delayed phase, iso-intensity on diffusion-weighted imaging (DWI), absence of double duct sign, presence of cysts within the lesion and focal thickening of the duodenum. 6 Similarly EUS serves as an adjunct to diagnostic imaging, and allows multi-modality assessment and biopsy, especially when malignancy is suspected. Consistent findings of fine needle aspiration specimens for histopathologically proven GP are stromal spindle cells.…”

Section: Discussionmentioning

confidence: 99%

“…reported a retrospective study of the MRI findings of 28 patients with histologically confirmed GP. The most suggestive signs of GP are signal hyperintensity in the delayed phase, iso‐intensity on diffusion‐weighted imaging (DWI), absence of double duct sign, presence of cysts within the lesion and focal thickening of the duodenum 6 . Similarly EUS serves as an adjunct to diagnostic imaging, and allows multi‐modality assessment and biopsy, especially when malignancy is suspected.…”

Section: Discussionmentioning

confidence: 99%

“…Patients often complain of abdominal pain, vomiting and marked weight loss due to gastric outlet obstruction from duodenal stenosis. [6][7][8][9][10] Despite the distal bile duct passing through the head of the pancreas, obstructive jaundice is an uncommon presentation. 7,9,11 Management of this condition lies in the ability to recognize and differentiate it from other forms of chronic pancreatitis, as well as from a pancreatic or peri-ampullary malignancy which it often mimics.…”

Section: Introductionmentioning

confidence: 99%

“…The demographic of patients with GP are predominantly males, aged 40–50 years old, with a history of alcohol misuse. Patients often complain of abdominal pain, vomiting and marked weight loss due to gastric outlet obstruction from duodenal stenosis 6–10 . Despite the distal bile duct passing through the head of the pancreas, obstructive jaundice is an uncommon presentation 7,9,11 …”

Section: Introductionmentioning

confidence: 99%

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Could it be groove pancreatitis? A frequently misdiagnosed condition with a surgical solution

Teo

Suthananthan

Pereira

et al. 2022

ANZ Journal of Surgery

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Background: Groove pancreatitis (GP) is an underrecognised subtype of chronic pancreatitis, focally affecting the area between the duodenum and pancreatic head. It most commonly affects males between 40 and 50 years of age with a history of alcohol misuse. Patients most commonly complain of abdominal pain and vomiting. Due to its focal nature, it is a potentially surgically treatable form of chronic pancreatitis. We report results of patients surgically treated for groove pancreatitis followed by a literature review of patient outcomes post resection. Methods: A retrospective chart review of patients with histopathologically confirmed GP post-surgical resection at the Princess Alexandra Hospital and Greenslopes Private Hospital in Brisbane, Australia was conducted between 2013 and 2020. Diagnosis was confirmed histologically when Brunner gland hyperplasia and chronic inflammation/fibrosis were found within the pancreaticoduodenal interface. Preoperative and postoperative symptoms were analysed along with complications. Additionally, a systematic review on outcomes of patients undergoing pancreaticoduodenectomy (PD) for GP was performed from three databases. Results: Eight patients underwent surgery for GP. Elimination of preoperative symptoms was achieved in five of the eight patients. Major complications included one take back to theatre for pancreatic leak. Our literature review found complete resolution of pain and vomiting in 80% of GP patients after PD. Conclusion: Optimal management of GP begins with early recognition. Symptoms from GP are likely to respond well to surgical intervention. We advocate for aggressive surgical resection in a patient with a high index of suspicion for GP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Could it be groove pancreatitis? A frequently misdiagnosed condition with a surgical solution

Teo

Suthananthan

Pereira

et al. 2022

ANZ Journal of Surgery

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“…Eligibility criteria were original studies including 8 or more patients, written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard (Figure 1 ). Finally, 14 studies were included in our systematic review[ 2 , 3 , 7 , 9 , 11 , 12 , 15 - 22 ].…”

Section: Methodsmentioning

confidence: 99%

Imaging of paraduodenal pancreatitis: A systematic review

Bonatti¹,

Pretis²,

Zamboni³

et al. 2023

World J Radiol

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BACKGROUND Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with pancreatic cancer. There are two main histological variants of PP, the cystic and the solid, with slightly different imaging appearances. Moreover, imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition, namely alcohol intake and smoking. AIM To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines. A Literature search was performed on PubMed, Embase and Cochrane Library using (groove pancreatitis [Title/Abstract]) OR (PP [Title/Abstract]) as key words. A total of 593 articles were considered for inclusion. After eliminating duplicates, and title and abstract screening, 53 full-text articles were assessed for eligibility. Eligibility criteria were: Original studies including 8 or more patients, fully written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard. Finally, 14 studies were included in our systematic review. RESULTS Computed tomography (CT) findings were described in 292 patients, magnetic resonance imaging (MRI) findings in 231 and endoscopic ultrasound (EUS) findings in 115. Duodenal wall thickening was observed in 88.8% of the cases: Detection rate was 96.5% at EUS, 91.0% at MRI and 84.1% at CT. Second duodenal portion increased enhancement was recognizable in 76.3% of the cases: Detection rate was 84.4% at MRI and 72.1% at CT. Cysts within the duodenal wall were detected in 82.6% of the cases: Detection rate was 94.4% at EUS, 81.9% at MRI and 75.7% at CT. A solid mass in the groove region was described in 40.9% of the cases; in 78.3% of the cases, it showed patchy enhancement in the portal venous phase, and in 100% appeared iso/hyperintense during delayed phase imaging. Only 3.6% of the lesions showed restricted diffusion. The prevalence of radiological signs of chronic obstructive pancreatitis, namely main pancreatic duct dilatation, pancreatic calcifications, and pancreatic cysts, was extremely variable in the different articles. CONCLUSION PP has peculiar imaging findings. MRI is the best radiological imaging modality for diagnosing PP, but EUS is more accurate than MRI in depicting duodenal wall alterations.

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