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He M, Wang X, Xu J, Li J, Chang X, Zins M, Jin Z, Xue H. Diffuse Involvement of Pancreas is not Always Autoimmune Pancreatitis. Acad Radiol 2022; 29:1523-1531. [PMID: 35279380 DOI: 10.1016/j.acra.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/09/2022] [Accepted: 01/16/2022] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the prevalence of diffuse involvement of pancreas and to identify the findings of malignancies using enhancement computed tomography (CT). MATERIALS AND METHODS A total of 1,0249 patients performed enhancement CT in our hospital over 62 months were investigated and the final study cohort includes 245 patients (170 males, 75 females; mean age, 56.94 ± 12.17 years). The reference standard is the final clinical/pathological diagnosis. The lesion-to-aorta enhancement ratio (LAR) on the pancreatic arterial phase, portal phase and delayed phase (DP) and the traditional CT findings were evaluated. Intergroup comparisons between malignancies and non-malignancies lesions were performed. Univariate and multivariate analyses were conducted to identify findings predicting malignancies. RESULTS The prevalence of malignancy was 45.3% (111/245) of diffuse enlargement of pancreas. All benign lesions were autoimmune pancreatitis 54.7% (n = 134). The most common malignant lesion was pancreatic ductal adenocarcinoma (n = 88, 35.9%). Other rare lesions with malignant potential included pancreatic neuroendocrine tumor (n = 11, 4.5%), lymphoma (n = 4, 1.6%), metastasis (n = 4, 1.6%), solid pseudopapillary neoplasm (n = 3, 1.2%) and acinar cell carcinoma (n = 1, 0.4%). Residual normal pancreas parenchyma, heterogeneity, short axis (cut-off value, 3.15 cm) and LARDP (cut-off value, 0.75) were independent predictors of malignancies. When the above predictors were combined, a sensitivity of 94.2%, a specificity of 90.8% were attained. CONCLUSION Diffuse involvement of the pancreas is rare and is not a specific sign of autoimmune pancreatitis, and it is associated with a wide spectrum of malignant conditions. Dynamic enhancement CT is helpful to identifying malignancies.
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Affiliation(s)
- Ming He
- Department of Radiology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China; Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Xiheng Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Jin Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Juan Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Marc Zins
- Department of Rathology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China.
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Yuan Z, Yan H, Ling W, Luo Y. Contrast-enhanced ultrasound of pancreatic melanoma: A case report and literature review. Front Oncol 2022; 12:989638. [PMID: 36147915 PMCID: PMC9485595 DOI: 10.3389/fonc.2022.989638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Melanoma is a malignant tumor that originates from melanocytes, most of which are of cutaneous origin. Most melanomas identified in the pancreas are metastatic, and primary pancreatic melanoma is extremely rare and has rarely been discussed. The correct preoperative diagnosis of pancreatic metastatic melanoma, especially primary melanoma, is challenging. Herein, we report a 43-year-old man who presented to our hospital due to unexplained left abdominal distension and pain. Abdominal ultrasound examination demonstrated multiple space-occupying lesions of the pancreas, and hypoechoic masses partially filled the splenic vein behind the pancreatic body. In the contrast-enhanced ultrasound (CEUS), all of these lesions showed iso-enhancement to slight hypo-enhancement in the arterial phase and hypo-enhancement in the venous phase. Masses in the splenic vein also showed hypo-enhancement. Imaging features suggested that the pancreatic lesions were malignant tumors. The tumor markers carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 19-9 were within normal limits. Based on clinical symptoms, imaging findings and incidence of pancreatic tumors, the patient’s clinical diagnosis was pancreatic carcinoma. Surgery was performed for the patient, while postoperative pathology confirmed malignant melanoma of the pancreas. Therefore, it is significant to identify the clinical and imaging manifestations of pancreatic melanoma in order to better manage the disease. Herein, we reported this case and reviewed the literature from 2000 to 2021 on the clinical and imaging features of 26 patients with pancreatic melanoma. It may improve clinicians’ awareness of the clinical and imaging performance of pancreatic melanoma, resulting in improved diagnosis, differential diagnosis, treatment, and outcomes.
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Han X, Yang J, Luo J, Chen P, Zhang Z, Alu A, Xiao Y, Ma X. Application of CT-Based Radiomics in Discriminating Pancreatic Cystadenomas From Pancreatic Neuroendocrine Tumors Using Machine Learning Methods. Front Oncol 2021; 11:606677. [PMID: 34367940 PMCID: PMC8339967 DOI: 10.3389/fonc.2021.606677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives The purpose of this study aimed at investigating the reliability of radiomics features extracted from contrast-enhanced CT in differentiating pancreatic cystadenomas from pancreatic neuroendocrine tumors (PNETs) using machine-learning methods. Methods In this study, a total number of 120 patients, including 66 pancreatic cystadenomas patients and 54 PNETs patients were enrolled. Forty-eight radiomic features were extracted from contrast-enhanced CT images using LIFEx software. Five feature selection methods were adopted to determine the appropriate features for classifiers. Then, nine machine learning classifiers were employed to build predictive models. The performance of the forty-five models was evaluated with area under the curve (AUC), accuracy, sensitivity, specificity, and F1 score in the testing group. Results The predictive models exhibited reliable ability of differentiating pancreatic cystadenomas from PNETs when combined with suitable selection methods. A combination of DC as the selection method and RF as the classifier, as well as Xgboost+RF, demonstrated the best discriminative ability, with the highest AUC of 0.997 in the testing group. Conclusions Radiomics-based machine learning methods might be a noninvasive tool to assist in differentiating pancreatic cystadenomas and PNETs.
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Affiliation(s)
- Xuejiao Han
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jingwen Luo
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Pengan Chen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zilong Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Aqu Alu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinan Xiao
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Zhao S, Su W, Deng L, Chen Y, Zuo C, Shao C, Ren F. Pancreatic sarcomatoid carcinoma: CT, MRI, and 18F-FDG PET/CT features. Clin Radiol 2020; 75:397.e7-397.e14. [PMID: 32044096 DOI: 10.1016/j.crad.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
AIM To investigate computed tomography (CT), magnetic resonance imaging (MRI), and combined 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/CT features of pancreatic sarcomatoid carcinoma (PSC). MATERIALS AND METHODS The hospital database was searched retrospectively for the patients with PSC confirmed at histopathology after surgery. Ten patients who underwent unenhanced and enhanced CT (n=4), unenhanced and enhanced MRI (n=2), 18F-FDG PET/CT (n=2), and both enhanced CT and 18F-FDG PET/CT (n=2) were enrolled. Two patients underwent additional delayed PET/CT. The maximum standardised uptake value (SUVmax) was measured on PET/CT images. RESULTS Eleven lesions were detected in 10 patients. Solid and cystic components (n=6), intratumoural haemorrhage (n=1), nodular calcification (n=2), main pancreatic duct dilatation resulted from lesion obstruction (n=5) or compression (n=3), cholangiectasis (n=5), vascular and peripheral organ invasion (n=5 and 6, respectively), hepatic and lymphatic metastases (n=4 and 2, respectively) were detected. All five lesions in four patients who underwent PET/CT showed intense FDG uptake on PET/CT with SUVmax (16, range 10.9-21.1). Increase of FDG uptake (SUVmax = 18.9, 20.1, and 27.3, respectively) was revealed on the delayed scan of three lesions in two patients. CONCLUSIONS PSCs were more commonly ill-defined solid cystic masses, which caused pancreatic duct obstruction/compression without pancreatic parenchymal atrophy, and these masses on PET/CT showed high FDG uptake on both initial and delayed PET/CT.
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Affiliation(s)
- S Zhao
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - W Su
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - L Deng
- Department of Pathology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Y Chen
- Department of Pathology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - C Zuo
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - C Shao
- Department of Radiology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
| | - F Ren
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
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Raposo Rodríguez L, Fernández García N, Tovar Salazar D, Gómez Illán R, Díaz Sánchez T. Imaging findings for mucinous tumors tumortumorof the abdomen and pelvis. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Imaging findings for mucinous tumors of the abdomen and pelvis. RADIOLOGIA 2019; 61:370-387. [PMID: 31078302 DOI: 10.1016/j.rx.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
This article aims to describe the imaging findings for mucinous tumors of the abdomen and pelvis, which have a similar appearance on imaging tests regardless of the organ in which they develop. Due to the high water content of mucus, the appearance of these tumors is generally similar to that of water on ultrasonography, computed tomography, and magnetic resonance imaging. Another common feature of mucin-producing tumors is that calcifications are often present. The rupture of these lesions and accumulation of mucinous material in the peritoneal cavity gives rise to pseudomyxoma peritonei. It is important to identify mucinous tumors because they have a different prognosis and clinical course than non-mucinous tumors and require different management. Depending on their anatomic location and their imaging characteristics, the treatment approach varies from follow-up to radical surgery together with chemotherapy or radiotherapy or both.
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Li J, Lu J, Liang P, Li A, Hu Y, Shen Y, Hu D, Li Z. Differentiation of atypical pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas: Using whole-tumor CT texture analysis as quantitative biomarkers. Cancer Med 2018; 7:4924-4931. [PMID: 30151864 PMCID: PMC6198241 DOI: 10.1002/cam4.1746] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background To explore the application value of computed tomography (CT) texture analysis in differentiating atypical pancreatic neuroendocrine tumors (pNET) from pancreatic ductal adenocarcinomas (PDAC). Materials and methods This single‐center retrospective study was approved by local institutional review board, and the requirement for informed consent was waived. We retrospectively analyzed 127 patients with 50 PDACs and 77 pNETs in pathology database between January 2012 and May 2017.These patients successfully finished preoperative contrast‐enhanced CT test. Texture parameters (mean, median, 5th, 10th, 25th, 75th, 90th percentiles, skewness, kurtosis and entropy) were extracted from portal images and compared between PDAC and 77 pNET groups using proper statistical method. The optimal parameters for differentiating PDACs and atypical pNETs were gained through receiver operating characteristic (ROC) curves. Results On the basis of arterial enhancement, 52 pNETs (67%, 52/77) were typical hypervascular and 25 pNETs (32%, 25/77) were atypical hypovascular. Compared with PDACs, atypical pNETs had statistically higher mean, median, 5th, 10th, and 25th percentiles (P = 0.006, 0.024, 0.000, 0.001, 0.021, respectively) and statistically lower skewness (P = 0.017). However, there were no difference for 75th, 90th percentiles, kurtosis and entropy between these two tumors (P = 0.232, 0.415, 0.143, 0.291, respectively). For differentiating PDACs and atypical pNETs, 5th percentile and 5th+skewness were optimal parameters for alone and combined diagnosis, respectively. Conclusion Volumetric CT texture features, especially combined diagnosis of 5th+skewness can be used as a quantitative tool to distinguish atypical pNETs from PDACs.
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Affiliation(s)
- Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Shi Y, Gao F, Li Y, Tao S, Yu B, Liu Z, Liu Y, Glaser KJ, Ehman RL, Guo Q. Differentiation of benign and malignant solid pancreatic masses using magnetic resonance elastography with spin-echo echo planar imaging and three-dimensional inversion reconstruction: a prospective study. Eur Radiol 2018; 28:936-945. [PMID: 28986646 PMCID: PMC5812826 DOI: 10.1007/s00330-017-5062-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 08/11/2017] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the diagnostic performance of MR elastography (MRE) and compare it with serum CA19-9 in differentiating malignant from benign pancreatic masses, with emphasis on differentiating between pancreatic ductal adenocarcinoma (PDAC) and mass-forming pancreatitis (MFP). METHODS We performed a prospective, consecutive, 24-month study in 85 patients with solid pancreatic masses confirmed by histopathologic examinations. The mass stiffness and stiffness ratio (calculated as the ratio of mass stiffness to the parenchymal stiffness) were assessed. The diagnostic accuracy was analysed by calculating the area under the ROC curve (AUROC). RESULTS The final diagnosis included 54 malignant tumours (43 patients with PDAC) and 31 benign masses (24 patients with MFP). The stiffness ratio showed better diagnostic performance than the mass stiffness and serum CA19-9 for the differentiation between malignant and benign masses (AUC: 0.912 vs. 0.845 vs. 0.702; P = 0.026, P < 0.001) and, specifically, between PDAC and MFP (AUC: 0.955 vs. 0.882 vs. 0.745; P = 0.026, P = 0.003). The sensitivity, specificity, and accuracy of stiffness ratio for the differentiation of PDAC and MFP were all higher than 0.9. CONCLUSIONS MRE presents an effective and quantitative strategy for non-invasive differentiation between PDAC and MFP based on their mechanical properties. KEY POINTS • 3D MRE is useful for calculating stiffness of solid pancreatic tumours. • Stiffness ratio outperformed stiffness and CA19-9 for differentiating PDAC from MFP. • Incorporation of 3D MRE into a standard MRI protocol is recommended.
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Affiliation(s)
- Yu Shi
- Department of Radiology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China
| | - Feng Gao
- Department of Hepato-Pancreato-Biliary Tumour Surgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yue Li
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Bing Yu
- Department of Radiology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yanqing Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China.
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Park H, Jang K, Song K, Kim S, Kim Y, Cha M, Choi SY, Min K. Value of unenhanced MRI with diffusion-weighted imaging for detection of primary small (≤20 mm) solid pancreatic tumours and prediction of pancreatic ductal adenocarcinoma. Clin Radiol 2017; 72:1076-1084. [DOI: 10.1016/j.crad.2017.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023]
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Søreide JA, Undersrud ES, Al-Saiddi MSS, Tholfsen T, Søreide K. Primary Leiomyosarcoma of the Pancreas-a Case Report and a Comprehensive Review. J Gastrointest Cancer 2017; 47:358-365. [PMID: 27631424 PMCID: PMC5138273 DOI: 10.1007/s12029-016-9872-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose Primary mesenchymal tumors of the pancreas are rare, with leiomyosarcomas the most encountered entities among the pancreatic sarcomas. With few exceptions, single case reports published over the last six decades constitute the entire scientific literature on this topic. Thus, evidence regarding clinical decision-making is scant. Methods Based on a case report and an extensive literature search in PubMed, we discuss the clinical aspects and current management of this rare malignancy. Results We identified only two papers with more than a single case presentation; these institutional patient series were limited to five and nine patients. Additionally, a few papers sought to summarize the individual case reports published in the English and/or Chinese language. The clinical presentation is rather non-specific. Moreover, modern imaging modalities are insufficiently accurate to diagnose leiomyosarcoma of the pancreas. Treatment goals include a complete resection with free margins. Proper morphologic examination using immunohistochemistry and the application of a grading system are clinically important for prognostication. The efficacy of adjuvant treatments has not been established. Conclusion Primary pancreatic leiomyosarcoma is extremely rare, and the scientific literature is primarily based on single case reports. Conclusions on management and prognosis should be drawn with caution. A multidisciplinary team consultation is warranted to discuss a thorough individual treatment plan based on the available scientific literature, despite its low evidence level.
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Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | | | - Tore Tholfsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
Pancreatic diseases, chronic pancreatitis, pancreatic cancer and diabetes mellitus, taken together, occur in >10% of the world population. Pancreatic diseases, as with other diseases, benefit from early intervention and appropriate diagnosis. Although imaging technologies have given clinicians an unprecedented toolbox to aid in clinical decision-making, advances in these technologies and development of molecular-based diagnostic tools could enable physicians to identify diseases at an even earlier stage and, thereby, improve patient outcomes. In this Review, we discuss and identify gaps in the use of imaging techniques for the early detection and appropriate treatment stratification of various pancreatic diseases, including diabetes mellitus, acute and chronic pancreatitis and pancreatic cancer. Imaging techniques discussed are MRI, CT, PET and ultrasonography. Additionally, the identification of new molecular targets for imaging and the development of contrast agents that are able to give molecular information in noninvasive radionuclear imaging and ultrasonography are emerging areas of innovation that could lead to increased diagnostic accuracy and improved patient outcomes.
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Affiliation(s)
- Julien Dimastromatteo
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Building MR5, Charlottesville, Virginia 22903, USA
| | - Teresa Brentnall
- Division of Gastroenterology, Digestive Diseases Center, 1959 Northeast Pacific Street, Seattle, Washington 98195, USA
| | - Kimberly A Kelly
- Department of Biomedical Engineering, University of Virginia, 415 Lane Road, Building MR5, Charlottesville, Virginia 22903, USA
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Jeon SK, Lee JM, Joo I, Lee ES, Park HJ, Jang JY, Ryu JK, Lee KB, Han JK. Nonhypervascular Pancreatic Neuroendocrine Tumors: Differential Diagnosis from Pancreatic Ductal Adenocarcinomas at MR Imaging-Retrospective Cross-sectional Study. Radiology 2017; 284:77-87. [PMID: 28092495 DOI: 10.1148/radiol.2016160586] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To determine useful magnetic resonance (MR) imaging features to differentiate nonhypervascular pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal adenocarcinomas (PDACs). Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Seventy-four patients with surgically confirmed PNETs and 82 patients with PDACs who underwent gadobutrol-enhanced MR imaging were included. Two radiologists independently evaluated the morphologic characteristics and temporal enhancement patterns of each tumor. Quantitative analysis, including measurement of tumor size, maximal upstream parenchymal thickness (MUPT), contrast-to-noise ratio, and apparent diffusion coefficient values, was performed. Uni- and multivariate logistic regression analyses were performed to identify relevant features to differentiate between PNETs and PDACs. Results On the basis of arterial enhancement, 38 PNETs (51%, 38 of 74) were hypervascular and 36 PNETs (49%, 36 of 74) were nonhypervascular. At MR imaging, nonhypervascular PNETs showed significantly higher frequencies of a well-defined margin, portal hyper- or isoenhancement, and MUPT of 10 mm or greater but lower frequencies of ductal dilatation, vascular invasion, and peripancreatic infiltration when compared with PDACs (P < .05 for all). At multivariate analysis, a well-defined margin and portal hyper- or isoenhancement were independent significant differentiators of PNETs from PDACs (odds ratio, 20.3 and 16.1, respectively). When applying the criteria of a well-defined margin and portal hyper- or isoenhancement, 64% of sensitivity and 99% of specificity were observed for the differential diagnosis of PNETs from PDACs. Conclusion A well-defined margin and hyper- or isoenhancement in the portal venous phase are useful MR imaging features that are more common in nonhypervascular PNETs and may help discriminate nonhypervascular PNETs from PDACs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Sun Kyung Jeon
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Jeong Min Lee
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Ijin Joo
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Eun Sun Lee
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Hyun Jeong Park
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Jin-Young Jang
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Ji Kon Ryu
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Kyung Bun Lee
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
| | - Joon Koo Han
- From the Departments of Radiology (S.K.J., J.M.L., I.J., J.K.H.), Surgery (J.Y.J.), and Pathology (K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; Department of Radiology (J.M.L., J.K.H.) and Division of Gastroenterology, Department of Internal Medicine, (J.K.R.), Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L., H.J.P.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.)
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13
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Abstract
ABBREVIATIONS FNA = fine-needle aspirate IPAS = intrapancreatic accessory spleen PNET = pancreatic neuroendocrine tumor.
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