Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Pictorial Review of Rare Pancreatic Tumors and Tumor-Like Lesions

췌장에서 생기는 희귀 종양 및 종양 유사 병변들의 영상 소견

  • Seung Jae Lee (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Sang Soo Shin (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Suk Hee Heo (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital) ;
  • Yong Yeon Jeong (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital)
  • 이승재 (전남대학교 의과대학 전남대학교병원 영상의학과) ;
  • 신상수 (전남대학교 의과대학 전남대학교병원 영상의학과) ;
  • 허숙희 (전남대학교 의과대학 화순전남대학교병원 영상의학과) ;
  • 정용연 (전남대학교 의과대학 화순전남대학교병원 영상의학과)
  • Received : 2020.02.18
  • Accepted : 2020.04.09
  • Published : 2020.09.01
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Abstract

Various types of tumors and tumor-like lesions may affect the pancreas. Among them, pancreatic ductal adenocarcinoma is the most common and is generally referred to as "pancreatic cancer." Recently, the detection rates of rare pancreatic tumors and tumor-like lesions have increased owing to technological advancements and increased frequency of imaging tests. Considering that rare pancreatic tumors and tumor-like lesions differ from pancreatic ductal adenocarcinoma in terms of the treatment plan and prognosis, the differential diagnosis of these diseases is clinically relevant. Various imaging tests play an important role in the differential diagnoses of rare tumors, such as acinar cell carcinoma and schwannoma, tumor-like lesions, such as autoimmune pancreatitis and inflammatory pseudotumor, and pancreatic ductal adenocarcinoma, but accurately distinguishing these diseases solely based on imaging findings is difficult. The aim of this pictorial review was to present the imaging findings of rare pancreatic tumors and tumor-like lesions and discuss important points for the differential diagnosis.

췌장에는 다양한 종류의 종양 및 종양 유사 병변들이 생길 수 있다. 이 가운데, 췌장선암은 췌장의 가장 흔한 종양으로서 일반적으로 췌장암이라고 하면 이 종양을 가리킨다. 최근에는 영상 검사의 기술적 진보와 이용이 증가하면서 췌장의 희귀 종양 및 종양 유사 병변들의 발견 빈도가 증가하고 있다. 췌장의 드문 종양 및 종양과 유사한 병변들은 치료 방침과 예후가 췌장선암과 다르기 때문에 이들 질환의 감별은 임상적으로 중요한 의의가 있다. 영상 검사는 포상세포암이나 신경초종 등의 희귀 종양 및 자가면역 췌장염 또는 염증성 거짓종양과 같은 종양 유사 병변들과 췌장선암의 감별 진단에 중요한 역할을 하지만 영상 소견만으로 이들 질환을 정확히 구분하는 것은 한계가 있다. 이 논문에서는 췌장에서 생길 수 있는 희귀 종양 및 종양 유사 병변들의 다양한 영상 소견들과 췌장선암과의 감별에 있어 도움이 되는 특징들을 제시하고자 한다.

Keywords

Acknowledgement

This work was supported by the funds from the National Research Foundation of Korea (2018R1D1A3B07043473) and Chonnam National University in South Korea (2020-1910).

References

  1. Stauffer JA, Asbun HJ. Rare tumors and lesions of the pancreas. Surg Clin North Am 2018;98:169-188 
  2. Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019;10:10-27 
  3. Choi IW, Shin SS, Heo SH, Jeong YY. Imaging diagnosis and management of pancreatic cystic neoplasms. J Korean Soc Radiol 2019;80:412-424 
  4. Steinman J, Zaheer A, Kluger MD, Remotti H, Hecht EM. Rare pancreatic tumors. Abdom Radiol (NY) 2018;43:285-300 
  5. Dioguardi Burgio M, Ronot M, Vilgrain V. Rare solid tumor of the exocrine pancreas: a pictorial review. Semin Ultrasound CT MR 2019;40:483-499 
  6. Liszka L, Zielinska-Pajak E, Pajak J, Golka D. Colloid carcinoma of the pancreas: review of selected pathological and clinical aspects. Pathology 2008;40:655-663 
  7. Adsay NV, Pierson C, Sarkar F, Abrams J, Weaver D, Conlon KC, et al. Colloid (mucinous noncystic) carcinoma of the pancreas. Am J Surg Pathol 2001;25:26-42 
  8. Ichikawa T, Federle MP, Ohba S, Ohtomo K, Sugiyama A, Fujimoto H, et al. Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell, and giant cell types): CT and pathologic features in 14 patients. Abdom Imaging 2000;25:409-419 
  9. Maksymov V, Khalifa MA, Bussey A, Carter B, Hogan M. Undifferentiated (anaplastic) carcinoma of the pancreas with osteoclast-like giant cells showing various degree of pancreas duct involvement. A case report and literature review. JOP 2011;12:170-176 
  10. Hsu MY, Pan KT, Chu SY, Hung CF, Wu RC, Tseng JH. CT and MRI features of acinar cell carcinoma of the pancreas with pathological correlations. Clin Radiol 2010;65:223-229 
  11. Chiou YY, Chiang JH, Hwang JI, Yen CH, Tsay SH, Chang CY. Acinar cell carcinoma of the pancreas: clinical and computed tomography manifestations. J Comput Assist Tomogr 2004;28:180-186 
  12. Milanetto AC, Lico V, Blandamura S, Pasquali C. Primary leiomyosarcoma of the pancreas: report of a case treated by local excision and review of the literature. Surg Case Rep 2015;1:98 
  13. Paciorek ML, Ross GJ. MR imaging of primary pancreatic leiomyosarcoma. Br J Radiol 1998;71:561-563 
  14. Ercan M, Aziret M, Bal A, S,enturk A, Karaman K, Kahyaoglu Z, et al. Pancreatic schwannoma: a rare case and a brief literature review. Int J Surg Case Rep 2016;22:101-104 
  15. Moriya T, Kimura W, Hirai I, Takeshita A, Tezuka K, Watanabe T, et al. Pancreatic schwannoma: case report and an updated 30-year review of the literature yielding 47 cases. World J Gastroenterol 2012;18:1538-1544 
  16. Suzuki S, Kaji S, Koike N, Harada N, Hayashi T, Suzuki M, et al. Pancreatic schwannoma: a case report and literature review with special reference to imaging features. JOP 2010;11:31-35 
  17. Shetty AS, Menias CO. Rare pancreatic tumors. Magn Reson Imaging Clin N Am 2018;26:421-437 
  18. Strasser G, Kutilek M, Mazal P, Schima W. Mature teratoma of the pancreas: CT and MR findings. Eur Radiol 2002;12 Suppl 3:S56-S58 
  19. Li Z, Ke N, Liu X, Gong S. Mature cystic teratoma of the pancreas with 30 years of clinical course: a case report. Medicine (Baltimore) 2018;97:e0405 
  20. Kim HH, Cho CK, Hur YH, Koh YS, Kim JC, Kim HJ, et al. Pancreatic hamartoma diagnosed after surgical resection. J Korean Surg Soc 2012;83:330-334 
  21. McFaul CD, Vitone LJ, Campbell F, Azadeh B, Hughes ML, Garvey CJ, et al. Pancreatic hamartoma. Pancreatology 2004;4:533-537 
  22. Sampelean D, Adam M, Muntean V, Hanescu B, Domsa I. Pancreatic hamartoma and SAPHO syndrome: a case report. J Gastrointestin Liver Dis 2009;18:483-486 
  23. Kim JW, Shin SS, Heo SH, Jeong YY, Kang HK, Choi YD. Imaging findings of localized lymphoid hyperplasia of the pancreas: a case report. Korean J Radiol 2011;12:510-514 
  24. Hatzitheoklitos E, Buchler MW, Friess H, DiSebastiano P, Poch B, Beger HG, et al. Pseudolymphoma of the pancreas mimicking cancer. Pancreas 1994;9:668-670 
  25. Majumder S, Takahashi N, Chari ST. Autoimmune pancreatitis. Dig Dis Sci 2017;62:1762-1769 
  26. Khandelwal A, Shanbhogue AK, Takahashi N, Sandrasegaran K, Prasad SR. Recent advances in the diagnosis and management of autoimmune pancreatitis. AJR Am J Roentgenol 2014;202:1007-1021 
  27. Wolske KM, Ponnatapura J, Kolokythas O, Burke LMB, Tappouni R, Lalwani N. Chronic pancreatitis or pancreatic tumor? A problem-solving approach. Radiographics 2019;39:1965-1982 
  28. Takahashi N, Fletcher JG, Hough DM, Fidler JL, Kawashima A, Mandrekar JN, et al. Autoimmune pancreatitis: differentiation from pancreatic carcinoma and normal pancreas on the basis of enhancement characteristics at dual-phase CT. AJR Am J Roentgenol 2009;193:479-484 
  29. Sugiyama Y, Fujinaga Y, Kadoya M, Ueda K, Kurozumi M, Hamano H, et al. Characteristic magnetic resonance features of focal autoimmune pancreatitis useful for differentiation from pancreatic cancer. Jpn J Radiol 2012;30:296-309 
  30. Kamisawa T, Takuma K, Anjiki H, Egawa N, Hata T, Kurata M, et al. Differentiation of autoimmune pancreatitis from pancreatic cancer by diffusion-weighted MRI. Am J Gastroenterol 2010;105:1870-1875 
  31. Baiao JM, Martins RM, Correia JG, Jordao D, Vieira Caroco T, Caetano Oliveira R, et al. Inflammatory pseudotumor of the pancreas mimicking a pancreatic neoplasm. Case Rep Gastroenterol 2019;13:245-252 
  32. Patnana M, Sevrukov AB, Elsayes KM, Viswanathan C, Lubner M, Menias CO. Inflammatory pseudotumor: the great mimicker. AJR Am J Roentgenol 2012;198:W217-W227 
  33. Pungpapong S, Geiger XJ, Raimondo M. Inflammatory myofibroblastic tumor presenting as a pancreatic mass: a case report and review of the literature. JOP 2004;5:360-367 
  34. Park SB, Cho KS, Kim JK, Lee JH, Jeong AK, Kwon WJ, et al. Inflammatory pseudotumor (myoblastic tumor) of the genitourinary tract. AJR Am J Roentgenol 2008;191:1255-1262 
  35. Liu TH, Consorti ET. Inflammatory pseudotumor presenting as a cystic tumor of the pancreas. Am Surg 2000;66:993-997