Diagnostic strategy to distinguish non-neoplastic masses of the pancreas from pancreatic cancer
Main Article Content
Abstract
Background: Pancreatic cancer presents a significant challenge in oncology due to its aggressive nature and poor prognosis. Obtaining an accurate diagnosis can be difficult because of the presence of mimicking masses, which may correspond to chronic pancreatitis, pancreatic neuroendocrine tumors, pancreatic pseudocysts, autoimmune pancreatitis, or primary pancreatic lymphomas. The aim of this paper is to understand the distinctive features of these diseases in order to guide appropriate management and improve patient outcomes.
Methods: This article reviews the clinical presentation, diagnostic modalities, and differential diagnosis of pancreatic cancer and its mimicking masses.
Results: Pancreatic cancer often presents with nonspecific symptoms such as abdominal pain, weight loss, and jaundice. It requires a multidisciplinary diagnostic approach that includes clinical evaluation, imaging, laboratory tests, and, when possible, histological samplings. Mimicking masses such as chronic pancreatitis exhibit overlapping symptoms and imaging features with pancreatic cancer, making histopathological evaluations essential for differentiation. Pancreatic pseudocysts may mimic cancer on imaging but lack malignant potential, often resolving spontaneously or requiring a minimally invasive drainage procedure. Pancreatic neuroendocrine tumors, characterized by hormone secretion and distinct histological patterns, require specialized imaging modalities and tissue biopsy for accurate diagnosis. Autoimmune pancreatitis and primary pancreatic lymphomas present diagnostic challenges due to their autoimmune and lymphoproliferative symptoms, respectively, necessitating a combination of serological, histopathological, radiological and molecular analyses to obtain a definitive diagnosis.
Conclusion: Multidisciplinary approach integrating clinical expertise, advanced imaging techniques, and molecular diagnostics are crucial to diagnose pancreatic cancer and its mimicking masses. A good understanding of distinctive features can help for an accurate diagnosis and guide optimal management strategies. Continued research efforts are warranted to enhance diagnostic precision, identify novel biomarkers, and improve therapeutic outcomes for patients affected by these challenging conditions.
Keywords:
pancreatic cancer, chronic pancreatitis, pancreatic pseudocysts, pancreatic neuroendocrine tumors, IgG4-related disease, autoimmune pancreatitis, pancreatic lymphoma.
Article Details
How to Cite
MACK, Sahar; CHARTIER, Suzanne; FROSSAR, Jean- Louis.
Diagnostic strategy to distinguish non-neoplastic masses of the pancreas from pancreatic cancer.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5925>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5925.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Kobi M, Veillette G, Narurkar R, et al. Imaging and Management of Pancreatic Cancer. Semin Ultrasound CT MR. 2020;41(2):139-151. doi:10.1053/j.sult.2019.12.003
3. Centeno BA, Thomas SC. Non-Neoplastic Masses of the Pancreas. Monogr Clin Cytol. 2020; 26:42-52. doi:10.1159/000455734
4. ASGE Standards of Practice Committee, Eloubeidi MA, Decker GA, et al. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc. 2016;83(1):17-28.
doi:10.1016/j.gie.2015.09.009
5. Huang J, Lok V, Ngai CH, et al. Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer. Gastroenterology. 2021;160(3):744-754. doi:10.1053/j.gastro.2020.10.007
6. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3): 209-249. doi:10.3322/caac.21660
7. Brugel M, Carlier C, Reyes-Castellanos G, Callon S, Carrier A, Bouché O. Pesticides and pancreatic adenocarcinoma: A transversal epidemiological, environmental and mechanistic narrative review. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2022;54 (12):1605-1613. doi:10.1016/j.dld.2022.08.023
8. Chu LC, Goggins MG, Fishman EK. Diagnosis and Detection of Pancreatic Cancer. Cancer J Sudbury Mass. 2017;23(6):333-342. doi:10.1097/PPO.0000000000000290
9. Takaori K, Bassi C, Biankin A, et al. International Association of Pancreatology (IAP)/ European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. Pancreatol Off J Int Assoc Pancreatol IAP Al. 2016;16(1):14-27. doi:10.1016/j.pan.2015.10.013
10. O’Neill RS, Stoita A. Biomarkers in the diagnosis of pancreatic cancer: Are we closer to finding the golden ticket? World J Gastroenterol. 2021;27(26):4045-4087. doi:10.3748/wjg.v27.i26.4045
11. Gui JC, Yan WL, Liu XD. CA19-9 and CA242 as tumor markers for the diagnosis of pancreatic cancer: a meta-analysis. Clin Exp Med. 2014;14(2) :225-233. doi:10.1007/s10238-013-0234-9
12. Farina A, Dumonceau JM, Frossard JL, Hadengue A, Hochstrasser DF, Lescuyer P. Proteomic analysis of human bile from malignant biliary stenosis induced by pancreatic cancer. J Proteome Res. 2009;8(1):159-169.
doi:10.1021/pr8004925
13. Hruban RH, Adsay NV, Esposito I. Pancreatic ductal adenocarcinoma. In: Digestive System Tumours WHO Classification of Tumours, 5th Edition, Volume 1. Vol 1. 5th ed. International Agency for Research on Cancer, Lyon, 2019; 2019.
14. Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic pancreatitis. Lancet Lond Engl. 2020;396(10249):499-512. doi:10.1016/S0140-6736(20)31318-0
15. Klöppel G, Adsay NV. Chronic pancreatitis and the differential diagnosis versus pancreatic cancer. Arch Pathol Lab Med. 2009;133(3):382-387. doi:10.5858/133.3.382
16. Younan G. Pancreas Solid Tumors. Surg Clin North Am. 2020;100(3):565-580. doi:10.1016/j.suc.2020.02.008
17. Hanada K, Minami T, Shimizu A, et al. Roles of ERCP in the Early Diagnosis of Pancreatic Cancer. Diagn Basel Switz. 2019;9(1):30. doi:10.3390/diagnostics9010030
18. Syed A, Babich O, Rao B, et al. Endoscopic ultrasound guided fine-needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency. Diagn Cytopathol. 2019;47(11):1138-1144. doi:10.1002/dc.24277
19. Selvaggi SM. The value of concurrent endoscopic ultrasound-guided fine needle aspirates and needle core biopsies in the diagnosis of pancreatic neoplasms. Diagn Cytopathol. 2022;50(10):459-462. doi:10.1002/dc.25016
20. Klöppel G. Chronic pancreatitis, pseudotumors and other tumor-like lesions. Mod Pathol Off J U S Can Acad Pathol Inc. 2007;20 Suppl 1:S113-131. doi:10.1038/modpathol.3800690
21. Sand J, Nordback I. The differentiation between pancreatic neoplastic cysts and pancreatic pseudocyst. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc. 2005;94(2):161-164. doi:10.1177/145749690509400213
22. Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol. 2009;15(1):38-47. doi:10.3748/wjg.15.38
23. Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. 2006;63(4): 635-643. doi:10.1016/j.gie.2005.06.028
24. Gumaste VV, Aron J. Pseudocyst management: endoscopic drainage and other emerging techniques. J Clin Gastroenterol. 2010; 44(5):326-331. doi:10.1097/MCG.0b013e3181cd9d2f
25. Baron TH. Treatment of pancreatic pseudocysts, pancreatic necrosis, and pancreatic duct leaks. Gastrointest Endosc Clin N Am. 2007; 17(3):559-579, vii. doi:10.1016/j.giec.2007.05.013
26. Melman L, Azar R, Beddow K, et al. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Surg Endosc. 2009;23(2):267-271. doi:10.1007/s00464-008-0196-2
27. Ma ZY, Gong YF, Zhuang HK, et al. Pancreatic neuroendocrine tumors: A review of serum biomarkers, staging, and management. World J Gastroenterol. 2020;26(19):2305-2322. doi:10.3748/wjg.v26.i19.2305
28. Ro C, Chai W, Yu VE, Yu R. Pancreatic neuroendocrine tumors: biology, diagnosis, and treatment. Chin J Cancer. 2013;32(6):312-324. doi:10.5732/cjc.012.10295
29. Effraimidis G, Knigge U, Rossing M, Oturai P, Rasmussen ÅK, Feldt-Rasmussen U. Multiple endocrine neoplasia type 1 (MEN-1) and neuroendocrine neoplasms (NENs). Semin Cancer Biol. 2022;79:141-162.
doi:10.1016/j.semcancer.2021.04.011
30. Laks S, van Leeuwaarde R, Patel D, et al. Management recommendations for pancreatic manifestations of von Hippel-Lindau disease. Cancer. 2022;128(3):435-446. doi:10.1002/cncr.33978
31. Lewis RB, Lattin GE, Paal E. Pancreatic endocrine tumors: radiologic-clinicopathologic correlation. Radiogr Rev Publ Radiol Soc N Am Inc. 2010;30(6):1445-1464. doi:10.1148/rg.306105523
32. Franchellucci G, Andreozzi M, Carrara S, et al. Contrast Enhanced EUS for Predicting Solid Pancreatic Neuroendocrine Tumor Grade and Aggressiveness. Diagn Basel Switz. 2023;13(2):239. doi:10.3390/diagnostics13020239
33. Crinò SF, Ammendola S, Meneghetti A, et al. Comparison between EUS-guided fine-needle aspiration cytology and EUS-guided fine-needle biopsy histology for the evaluation of pancreatic neuroendocrine tumors. Pancreatol Off J Int Assoc Pancreatol IAP Al. 2021;21(2):443-450. doi:10.1016/j.pan.2020.12.015
34. Kloeppel G, Klimstra DS, Singhi AD. Pancreatic neuroendocrine neoplasms: Introduction. In: Digestive System Tumours WHO Classification of Tumours, 5th Edition, Volume 1. Vol 1. 5th ed. International Agency for Research on Cancer, Lyon, 2019; 2019.
35. Adsay NV, Singhi AD, Perren A. Pancreatic neuroendocrine carcinoma. In: Digestive System Tumours WHO Classification of Tumours, 5th Edition, Volume 1. Vol 1. 5th ed. International Agency for Research on Cancer, Lyon, 2019; 2019.
36. So H, Ko SW, Shin SH, et al. Comparison of EUS-guided ablation and surgical resection for nonfunctioning small pancreatic neuroendocrine tumors: a propensity score-matching study. Gastrointest Endosc. 2023;97(4):741-751.e1. doi:10.1016/j.gie.2022.11.004
37. Notohara K, Burgart LJ, Yadav D, Chari S, Smyrk TC. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol. 2003;27(8):1119-1127.
doi:10.1097/00000478-200308000-00009
38. Zamboni G, Lüttges J, Capelli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch Int J Pathol. 2004;445(6):552-563. doi:10.1007/s00428-004-1140-z
39. Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40(3):352-358.
doi:10.1097/MPA.0b013e3182142fd2
40. Vonlaufen A, Frossard JL. [Autoimmune pancreatitis]. Rev Med Suisse. 2010;6(261):1662-1666.
41. Mack S, Flattet Y, Bichard P, Frossard JL. Recent advances in the management of autoimmune pancreatitis in the era of artificial intelligence. World J Gastroenterol. 2022;28(48) :6867-6874. doi:10.3748/wjg.v28.i48.6867
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