Figure - available from: Journal of Gastrointestinal Cancer
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Radiological evidence for AIP. Axial CT abdominal imaging showing pancreatic head mass as indistinguishable from that formed by pancreatic cancer (a–e). Coronal view of CT abdomen showing pancreatic mass from AIP exhibiting a partial rim-enhancing sign (f). MRCP and reconstruction of a patient suffering from AIP exhibiting a sharp transition point at CBD stricture (g–j)
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Citations
... Patients with IDCP are often younger and show no gender preference. [55][56][57][58][59][60][61]. Especially in elder patients, AIP should therefore be distinguished wittingly from PDCA. ...
Purpose of Review
In this article, we review the ductal pancreatic adenocarcinoma, which is by far the most common solid tumor within the pancreas. We emphasize on the diagnosis and differential diagnoses of this tumor and discuss different imaging modalities.
Recent Findings
Recently major progress has been made in distinguishing different subtypes of tumors using immunolabeling and more recently genetic sequencing, which though is not the main purpose of this article. Because of the wide availability of modern medical imaging techniques, detection of precursor lesions and tumors in pancreatitis are increasingly discovered.
Summary
A large number of different lesions can mimic pancreatic adenocarcinomas. The most important differential diagnoses are anatomical variants, peripancreatic structures or tumors, rarer primary solid pancreatic tumors, cystic tumors, metastases or different variants of pancreatitis. Several precursor lesions can also be differentiated. The correct diagnosis of these precursor lesions and their differential diagnosis are vital, because the therapy of a PDCA is often invasive and requires careful planning. All major imaging techniques are suitable for pancreas imaging. Generally sonography of the abdomen will be the baseline diagnostic tool. In nearly all cases further examinations are required, especially CT, MRI plus MRCP, endosonography, possibly with additional ERCP and the ability for direct biopsy and PET-CT as a molecular imaging tool. In many cases different imaging techniques have to be combined depending on the specific question.
Pancreatitis, encompassing acute and chronic forms, and pancreatic cancer pose significant challenges to the exocrine tissue of the pancreas. Recurrence rates and complications following acute pancreatitis episodes can lead to long-term risks, including diabetes mellitus. Chronic pancreatitis can develop in approximately 15% of cases, regardless of the initial episode’s severity. Alcohol-induced pancreatitis, idiopathic causes, cigarette smoking, and hereditary pancreatitis contribute to the progression to chronic pancreatitis. Chronic pancreatitis is associated with an increased risk of pancreatic cancer, with older age at onset and smoking identified as risk factors. This scoping review aims to synthesise recent publications (2017–2022) on the diagnostic differentiation between pancreatitis and pancreatic cancer while identifying knowledge gaps in the field. The review focuses on biomarkers and imaging techniques in individuals with pancreatitis and pancreatic cancer. Promising biomarkers such as faecal elastase-1 and specific chemokines offer non-invasive ways to assess pancreatic insufficiency and detect early biomarkers for chronic pancreatitis. Imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), and positron emission tomography (PET), aid in differentiating between chronic pancreatitis and pancreatic cancer. However, accurately distinguishing between the two conditions remains a challenge, particularly when a mass is present in the head of the pancreas. Several knowledge gaps persist despite advancements in understanding the association between pancreatitis and pancreatic cancer, including the correlation between histopathological grading systems, non-invasive imaging techniques, and biomarkers in chronic pancreatitis to determine the risk of progression to pancreatic cancer, as well as differentiating between the two conditions. Further research is necessary to enhance our understanding of these aspects, which can ultimately improve the diagnosis and management of pancreatitis and pancreatic cancer.
