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Differential Diagnosis and Diagnostic Evaluation Algorithm

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Pancreatic Masses

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Abstract

Pancreatic masses encompass a variety of etiologies, with pancreatic adenocarcinoma being the most common solid lesion. Depending on the clinical scenario and specific imaging features, the differential diagnosis of a pancreatic lesion can be challenging, especially when underlying pancreatic pathology exists like chronic pancreatitis. The common diagnostic tree to differentiate pancreatic masses is based on cross-sectional imaging studies with contrast-enhanced computed tomography (CECT) being a valuable initial test. Based on the findings, a diagnosis can be frequently established. Nondiagnostic imaging findings require additional workup, with magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) being the main nonsurgical diagnostic tools. This article reviews common and uncommon solid and cystic pancreatic lesions, delineates their typical radiographic findings, compares the diagnostic yield of the imaging studies, and proposes a diagnostic algorithm guiding through common diagnostic challenges with the adequate diagnostic imaging technique.

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References

  1. Goodman M, Willmann JK, Jeffrey RB. Incidentally discovered solid pancreatic masses: imaging and clinical observations. Abdom Imaging. 2012;37:91–7.

    Article  PubMed  Google Scholar 

  2. de Jong K, Nio CY, Hermans JJ, Dijkgraaf MG, Gouma DJ, van Eijck CH, van Heel E, Klass G, Fockens P, Bruno MJ. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol. 2010;8:806–11.

    Article  PubMed  Google Scholar 

  3. Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol. 2010;105:2079–84.

    Article  PubMed  Google Scholar 

  4. Rosch T, Lorenz R, Braig C, Feuerbach S, Siewert JR, Schusdziarra V, Classen M. Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc. 1991;37:347–52.

    Article  CAS  PubMed  Google Scholar 

  5. Perumal S, Palaniappan R, Pillai SA, Velayutham V, Sathyanesan J. Predictors of malignancy in chronic calcific pancreatitis with head mass. World J Gastrointest Surg. 2013;5:97–103.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Yadav D, Notahara K, Smyrk TC, Clain JE, Pearson RK, Farnell MB, Chari ST. Idiopathic tumefactive chronic pancreatitis: clinical profile, histology, and natural history after resection. Clin Gastroenterol Hepatol. 2003;1:129–35.

    Article  PubMed  Google Scholar 

  7. Farrell JJ, Garber J, Sahani D, Brugge WR. EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc. 2004;60:927–36.

    Article  PubMed  Google Scholar 

  8. Hoki N, Mizuno N, Sawaki A, Tajika M, Takayama R, Shimizu Y, Bhatia V, Yamao K. Diagnosis of autoimmune pancreatitis using endoscopic ultrasonography. J Gastroenterol. 2009;44:154–9.

    Article  PubMed  Google Scholar 

  9. Dewhurst CE, Mortele KJ. Cystic tumors of the pancreas: imaging and management. Radiol Clin North Am. 2012;50:467–86.

    Article  PubMed  Google Scholar 

  10. Yoon WJ, Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin North Am. 2012;41:103–18.

    Article  PubMed  Google Scholar 

  11. Butte JM, Brennan MF, Gonen M, Tang LH, D’Angelica MI, Fong Y, Dematteo RP, Jarnagin WR, Allen PJ. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J Gastrointest Surg. 2011;15:350–7.

    Article  PubMed  Google Scholar 

  12. Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF. Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology. 1996;199:707–11.

    Article  CAS  PubMed  Google Scholar 

  13. Yao X, Ji Y, Zeng M, Rao S, Yang B. Solid pseudopapillary tumor of the pancreas: cross-sectional imaging and pathologic correlation. Pancreas. 2010;39:486–91.

    Article  PubMed  Google Scholar 

  14. Megibow AJ. Unusual solid pancreatic tumors. Radiol Clin North Am. 2012;50:499–513.

    Article  PubMed  Google Scholar 

  15. Byrne MF, Jowell PS. Gastrointestinal imaging: endoscopic ultrasound. Gastroenterology. 2002;122:1631–48.

    Article  PubMed  Google Scholar 

  16. Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol. 2000;95:2271–7.

    Article  CAS  PubMed  Google Scholar 

  17. Tenner SM, Banks PA, Wiersema MJ, Van Dam J. Evaluation of pancreatic disease by endoscopic ultrasonography. Am J Gastroenterol. 1997;92:18–26.

    CAS  PubMed  Google Scholar 

  18. Chatzipantelis P, Salla C, Konstantinou P, Karoumpalis I, Sakellariou S, Doumani I. Endoscopic ultrasound-guided fine-needle aspiration cytology of pancreatic neuroendocrine tumors: a study of 48 cases. Cancer. 2008;114:255–62.

    Article  PubMed  Google Scholar 

  19. Scatarige JC, Horton KM, Sheth S, Fishman EK. Pancreatic parenchymal metastases: observations on helical CT. Am J Roentgenol. 2001;176:695–9.

    Article  CAS  Google Scholar 

  20. Merkle EM, Boaz T, Kolokythas O, Haaga JR, Lewin JS, Brambs HJ. Metastases to the pancreas. Br J Radiol. 1998;71:1208–14.

    Article  CAS  PubMed  Google Scholar 

  21. Waters L, Si Q, Caraway N, Mody D, Staerkel G, Sneige N. Secondary tumors of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: A 10-year experience. Diagn Cytopathol. 2014;42(9):738–43.

    Article  PubMed  Google Scholar 

  22. Klein KA, Stephens DH, Welch TJ. CT characteristics of metastatic disease of the pancreas. Radiographics. 1998;18:369–78.

    Article  CAS  PubMed  Google Scholar 

  23. Ferrozzi F, Bova D, Campodonico F, Chiara FD, Passari A, Bassi P. Pancreatic metastases: CT assessment. Eur Radiol. 1997;7:241–5.

    Article  CAS  PubMed  Google Scholar 

  24. Palmowski M, Hacke N, Satzl S, Klauss M, Wente MN, Neukamm M, Kleeff J, Hallscheidt P. Metastasis to the pancreas: characterization by morphology and contrast enhancement features on CT and MRI. Pancreatology. 2008;8:199–203.

    Article  PubMed  Google Scholar 

  25. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.

    Article  PubMed  Google Scholar 

  26. http://seer.cancer.gov/statfacts/html/pancreas.html. SEER 18 2007–2011, Age-Adjusted, pancreas

  27. Muniraj T, Jamidar PA, Aslanian HR. Pancreatic cancer: a comprehensive review and update. Dis Mon. 2013;59:368–402.

    Article  PubMed  Google Scholar 

  28. Ben Q, Xu M, Ning X, Liu J, Hong S, Huang W, Zhang H, Li Z. Diabetes mellitus and risk of pancreatic cancer: a meta-analysis of cohort studies. Eur J Cancer. 2011;47:1928–37.

    Article  PubMed  Google Scholar 

  29. Pannala R, Leirness JB, Bamlet WR, Basu A, Petersen GM, Chari ST. Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus. Gastroenterology. 2008;134:981–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Permert J, Ihse I, Jorfeldt L, von Schenck H, Arnqvist HJ, Larsson J. Pancreatic cancer is associated with impaired glucose metabolism. Eur J Surg. 1993;159:101–7.

    CAS  PubMed  Google Scholar 

  31. Batabyal P, Vander Hoorn S, Christophi C, Nikfarjam M. Association of diabetes mellitus and pancreatic adenocarcinoma: a meta-analysis of 88 studies. Ann Surg Oncol. 2014;21(7):2453–62.

    Article  PubMed  Google Scholar 

  32. Duffy MJ, Sturgeon C, Lamerz R, Haglund C, Holubec VL, Klapdor R, Nicolini A, Topolcan O, Heinemann V. Tumor markers in pancreatic cancer: a European group on tumor markers (EGTM) status report. Ann Oncol. 2010;21:441–7.

    Article  CAS  PubMed  Google Scholar 

  33. Rickes S, Unkrodt K, Neye H, Ocran KW, Wermke W. Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scand J Gastroenterol. 2002;37:1313–20.

    Article  CAS  PubMed  Google Scholar 

  34. Amin Z, Theis B, Russell RC, House C, Novelli M, Lees WR. Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT. Clin Radiol. 2006;61:996–1002.

    Article  CAS  PubMed  Google Scholar 

  35. Ahn SS, Kim MJ, Choi JY, Hong HS, Chung YE, Lim JS. Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol. 2009;19:2448–55.

    Article  PubMed  Google Scholar 

  36. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey Jr RB. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology. 2002;224:764–8.

    Article  PubMed  Google Scholar 

  37. Ahualli J. The double duct sign. Radiology. 2007;244:314–5.

    Article  PubMed  Google Scholar 

  38. Valls C, Andia E, Sanchez A, Fabregat J, Pozuelo O, Quintero JC, Serrano T, Garcia-Borobia F, Jorba R. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. Am J Roentgenol. 2002;178:821–6.

    Article  Google Scholar 

  39. Bronstein YL, Loyer EM, Kaur H, Choi H, David C, DuBrow RA, Broemeling LD, Cleary KR, Charnsangavej C. Detection of small pancreatic tumors with multiphasic helical CT. Am J Roentgenol. 2004;182:619–23.

    Article  Google Scholar 

  40. Karmazanovsky G, Fedorov V, Kubyshkin V, Kotchatkov A. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging. 2005;30:488–500.

    Article  CAS  PubMed  Google Scholar 

  41. Palazzo L, Roseau G, Gayet B, Vilgrain V, Belghiti J, Fekete F, Paolaggi JA. Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy. 1993;25:143–50.

    Article  CAS  PubMed  Google Scholar 

  42. Muller MF, Meyenberger C, Bertschinger P, Schaer R, Marincek B. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology. 1994;190:745–51.

    Article  CAS  PubMed  Google Scholar 

  43. Melzer E, Avidan B, Heyman Z, Coret A, Bar-Meir S. Preoperative assessment of blood vessel involvement in patients with pancreatic cancer. Isr J Med Sci. 1996;32:1086–8.

    CAS  PubMed  Google Scholar 

  44. Marty O, Aubertin JM, Bouillot JL, Hernigou A, Bloch F, Petite JP. Prospective comparison of ultrasound endoscopy and computed tomography in the assessment of locoregional invasiveness of malignant ampullar and pancreatic tumors verified surgically. Gastroenterol Clin Biol. 1995;19:197–203.

    CAS  PubMed  Google Scholar 

  45. Dufour B, Zins M, Vilgrain V, Levy P, Bernades P, Menu Y. Comparison between spiral x-ray computed tomography and endosonography in the diagnosis and staging of adenocarcinoma of the pancreas. Clinical preliminary study. Gastroenterol Clin Biol. 1997;21:124–30.

    CAS  PubMed  Google Scholar 

  46. Legmann P, Vignaux O, Dousset B, Baraza AJ, Palazzo L, Dumontier I, Coste J, Louvel A, Roseau G, Couturier D, Bonnin A. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. Am J Roentgenol. 1998;170:1315–22.

    Article  CAS  Google Scholar 

  47. Akahoshi K, Chijiiwa Y, Nakano I, Nawata H, Ogawa Y, Tanaka M, Nagai E, Tsuneyoshi M. Diagnosis and staging of pancreatic cancer by endoscopic ultrasound. Br J Radiol. 1998;71:492–6.

    Article  CAS  PubMed  Google Scholar 

  48. Gress FG, Hawes RH, Savides TJ, Ikenberry SO, Cummings O, Kopecky K, Sherman S, Wiersema M, Lehman GA. Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience. Gastrointest Endosc. 1999;50:786–91.

    Article  CAS  PubMed  Google Scholar 

  49. Ainsworth AP, Rafaelsen SR, Wamberg PA, Durup J, Pless TK, Mortensen MB. Is there a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography and magnetic resonance cholangiopancreatography? Endoscopy. 2003;35:1029–32.

    Article  CAS  PubMed  Google Scholar 

  50. Harrison JL, Millikan KW, Prinz RA, Zaidi S. Endoscopic ultrasound for diagnosis and staging of pancreatic tumors. Am Surg. 1999;65:659–64; discussion 664–5.

    CAS  PubMed  Google Scholar 

  51. Giovannini M, Thomas B, Erwan B, Christian P, Fabrice C, Benjamin E, Genevieve M, Paolo A, Pierre D, Robert Y, Walter S, Hanz S, Carl S, Christoph D, Pierre E, Jean-Luc VL, Jacques D, Peter V, Andrian S. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol. 2009;15:1587–93.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Eloubeidi MA, Varadarajulu S, Desai S, Shirley R, Heslin MJ, Mehra M, Arnoletti JP, Eltoum I, Wilcox CM, Vickers SM. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11:813–9.

    Article  PubMed  Google Scholar 

  53. Eloubeidi MA, Jhala D, Chhieng DC, Chen VK, Eltoum I, Vickers S, Mel Wilcox C, Jhala N. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer. 2003;99:285–92.

    Article  PubMed  Google Scholar 

  54. Buscail L, Faure P, Bournet B, Selves J, Escourrou J. Interventional endoscopic ultrasound in pancreatic diseases. Pancreatology. 2006;6:7–16.

    Article  PubMed  Google Scholar 

  55. Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012;75:319–31.

    Article  PubMed  Google Scholar 

  56. Klapman JB, Chang KJ, Lee JG, Nguyen P. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol. 2005;100:2658–61.

    Article  PubMed  Google Scholar 

  57. Catanzaro A, Richardson S, Veloso H, Isenberg GA, Wong RC, Sivak Jr MV, Chak A. Long-term follow-up of patients with clinically indeterminate suspicion of pancreatic cancer and normal EUS. Gastrointest Endosc. 2003;58:836–40.

    Article  PubMed  Google Scholar 

  58. Bhutani MS, Gress FG, Giovannini M, Erickson RA, Catalano MF, Chak A, Deprez PH, Faigel DO, Nguyen CC. The No Endosonographic Detection of Tumor (NEST) Study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy. 2004;36:385–9.

    Article  CAS  PubMed  Google Scholar 

  59. Eloubeidi MA, Varadarajulu S, Desai S, Wilcox CM. Value of repeat endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic cancer. J Gastroenterol Hepatol. 2008;23:567–70.

    Article  PubMed  Google Scholar 

  60. Suzuki R, Lee JH, Krishna SG, Ramireddy S, Qiao W, Weston B, Ross WA, Bhutani MS. Repeat endoscopic ultrasound-guided fine needle aspiration for solid pancreatic lesions at a tertiary referral center will alter the initial inconclusive result. J Gastrointestin Liver Dis. 2013;22:183–7.

    PubMed  Google Scholar 

  61. Tummala Md P, Rao Md S, Agarwal MB. Differential diagnosis of focal non-cystic pancreatic lesions with and without proximal dilation of pancreatic duct noted on CT scan. Clin Transl Gastroenterol. 2013;4, e42.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Singh S, Reddymasu S, Waheed S, Vail M, He J, Talapaneni J, Olyaee M. Endoscopic ultrasonography findings in patients with non-specific changes of the pancreas on computed tomography: a single-center experience. Dig Dis Sci. 2008;53:2799–804.

    Article  PubMed  Google Scholar 

  63. Agarwal B, Krishna NB, Labundy JL, Safdar R, Akduman EI. EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. Gastrointest Endosc. 2008;68:237–42; quiz 334, 335.

    Article  PubMed  Google Scholar 

  64. DeWitt J, Devereaux B, Chriswell M, McGreevy K, Howard T, Imperiale TF, Ciaccia D, Lane KA, Maglinte D, Kopecky K, LeBlanc J, McHenry L, Madura J, Aisen A, Cramer H, Cummings O, Sherman S. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med. 2004;141:753–63.

    Article  PubMed  Google Scholar 

  65. Agarwal B, Abu-Hamda E, Molke KL, Correa AM, Ho L. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol. 2004;99:844–50.

    Article  PubMed  Google Scholar 

  66. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol. 2002;97:1386–91.

    Article  PubMed  Google Scholar 

  67. Dewitt J, Devereaux BM, Lehman GA, Sherman S, Imperiale TF. Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol. 2006;4:717–25. quiz 664.

    Article  PubMed  Google Scholar 

  68. Tummala P, Junaidi O, Agarwal B. Imaging of pancreatic cancer: an overview. J Gastrointest Oncol. 2011;2:168–74.

    PubMed Central  PubMed  Google Scholar 

  69. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best practice & research. Clin Gastroenterol. 2010;24:349–58.

    Google Scholar 

  70. Yamada Y, Mori H, Matsumoto S, Kiyosue H, Hori Y, Hongo N. Pancreatic adenocarcinoma versus chronic pancreatitis: differentiation with triple-phase helical CT. Abdom Imaging. 2010;35:163–71.

    Article  PubMed  Google Scholar 

  71. Sandrasegaran K, Nutakki K, Tahir B, Dhanabal A, Tann M, Cote GA. Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer. Am J Roentgenol. 2013;201:1002–8.

    Article  Google Scholar 

  72. Norton ID, Zheng Y, Wiersema MS, Greenleaf J, Clain JE, Dimagno EP. Neural network analysis of EUS images to differentiate between pancreatic malignancy and pancreatitis. Gastrointest Endosc. 2001;54:625–9.

    Article  CAS  PubMed  Google Scholar 

  73. Li X, Xu W, Shi J, Lin Y, Zeng X. Endoscopic ultrasound elastography for differentiating between pancreatic adenocarcinoma and inflammatory masses: a meta-analysis. World J Gastroenterol. 2013;19:6284–91.

    Article  PubMed Central  PubMed  Google Scholar 

  74. Raimondo MY, Yab TC, Mahoney DW, Taylor WR, Anderson KS, Ahlquist DA. Methylated DNA markers in pancreatic juice discriminate pancreatic cancer from chronic pancreatitis and normal controls. Gastroenterology. 2013;144:S-90.

    Article  Google Scholar 

  75. Latham J, Sanjay P, Watt DG, Walsh SV, Tait IS. Groove pancreatitis: a case series and review of the literature. Scott Med J. 2013;58:e28–31.

    Article  CAS  PubMed  Google Scholar 

  76. Munigala S, Kanwal F, **an H, Scherrer JF, Agarwal B. Increased risk of pancreatic adenocarcinoma after acute pancreatitis. Clin Gastroenterol Hepatol. 2014;12(7):1143–1150.e1.

    Article  PubMed  Google Scholar 

  77. Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, Kim MH, Kloppel G, Lerch MM, Lohr M, Notohara K, Okazaki K, Schneider A, Zhang L. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40:352–8.

    Article  PubMed  Google Scholar 

  78. Sah RP, Chari ST. Autoimmune pancreatitis: an update on classification, diagnosis, natural history and management. Curr Gastroenterol Rep. 2012;14:95–105.

    Article  PubMed  Google Scholar 

  79. Mizuno N, Bhatia V, Hosoda W, Sawaki A, Hoki N, Hara K, Takagi T, Ko SB, Yatabe Y, Goto H, Yamao K. Histological diagnosis of autoimmune pancreatitis using EUS-guided Trucut biopsy: a comparison study with EUS-FNA. J Gastroenterol. 2009;44:742–50.

    Article  CAS  PubMed  Google Scholar 

  80. Zhang L, Notohara K, Levy MJ, Chari ST, Smyrk TC. IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis. Mod Pathol. 2007;20:23–8.

    Article  CAS  PubMed  Google Scholar 

  81. Chari ST, Takahashi N, Levy MJ, Smyrk TC, Clain JE, Pearson RK, Petersen BT, Topazian MA, Vege SS. A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol. 2009;7:1097–103.

    Article  CAS  PubMed  Google Scholar 

  82. Kamisawa T, Chari ST, Lerch MM, Kim MH, Gress TM, Shimosegawa T. Recent advances in autoimmune pancreatitis: type 1 and type 2. Gut. 2013;62:1373–80.

    Article  CAS  PubMed  Google Scholar 

  83. Yoon WJ, Lee JK, Lee KH, Ryu JK, Kim YT, Yoon YB. Cystic neoplasms of the exocrine pancreas: an update of a nationwide survey in Korea. Pancreas. 2008;37:254–8.

    Article  PubMed  Google Scholar 

  84. Tipton SG, Smyrk TC, Sarr MG, Thompson GB. Malignant potential of solid pseudopapillary neoplasm of the pancreas. Br J Surg. 2006;93:733–7.

    Article  CAS  PubMed  Google Scholar 

  85. Estrella JS, Li L, Rashid A, Wang H, Katz MH, Fleming JB, Abbruzzese JL. Solid pseudopapillary neoplasm of the pancreas: clinicopathologic and survival analyses of 64 cases from a single institution. Am J Surg Pathol. 2014;38:147–57.

    Article  PubMed  Google Scholar 

  86. Kloppel G, Hruban RH, Klimstra DS, Maitra A, Morohoshi T, Notohara K, Shimizu M, Terris B Solid-pseudopapillary neoplasm of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO Classification of Tumors of the Digestive System. 4th ed. WHO; 2010. p. 327–330.

    Google Scholar 

  87. Cantisani V, Mortele KJ, Levy A, Glickman JN, Ricci P, Passariello R, Ros PR, Silverman SG. MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. Am J Roentgenol. 2003;181:395–401.

    Article  Google Scholar 

  88. Jani N, Dewitt J, Eloubeidi M, Varadarajulu S, Appalaneni V, Hoffman B, Brugge W, Lee K, Khalid A, McGrath K. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy. 2008;40:200–3.

    Article  CAS  PubMed  Google Scholar 

  89. Lewis RB, Lattin Jr GE, Paal E. Pancreatic endocrine tumors: radiologic-clinicopathologic correlation. Radiographics. 2010;30:1445–64.

    Article  PubMed  Google Scholar 

  90. Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology. 2008;135:1469–92.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  91. Kulke MH, Anthony LB, Bushnell DL, de Herder WW, Goldsmith SJ, Klimstra DS, Marx SJ, Pasieka JL, Pommier RF, Yao JC, Jensen RT. NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas. 2010;39:735–52.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Seregni E, Ferrari L, Bajetta E, Martinetti A, Bombardieri E. Clinical significance of blood chromogranin A measurement in neuroendocrine tumours. Ann Oncol. 2001;12 Suppl 2:S69–72.

    Article  PubMed  Google Scholar 

  93. Dickson PV, Behrman SW. Management of pancreatic neuroendocrine tumors. Surg Clin North Am. 2013;93:675–91.

    Article  PubMed  Google Scholar 

  94. Campana D, Nori F, Piscitelli L, Morselli-Labate AM, Pezzilli R, Corinaldesi R, Tomassetti P. Chromogranin A: is it a useful marker of neuroendocrine tumors? J Clin Oncol. 2007;25:1967–73.

    Article  CAS  PubMed  Google Scholar 

  95. Stivanello M, Berruti A, Torta M, Termine A, Tampellini M, Gorzegno G, Angeli A, Dogliotti L. Circulating chromogranin A in the assessment of patients with neuroendocrine tumours. A single institution experience. Ann Oncol. 2001;12 Suppl 2:S73–7.

    Article  PubMed  Google Scholar 

  96. Sohn TA, Yeo CJ, Cameron JL, Nakeeb A, Lillemoe KD. Renal cell carcinoma metastatic to the pancreas: results of surgical management. J Gastrointest Surg. 2001;5:346–51.

    Article  CAS  PubMed  Google Scholar 

  97. Ascenti G, Visalli C, Genitori A, Certo A, Pitrone A, Mazziotti S. Multiple hypervascular pancreatic metastases from renal cell carcinoma: dynamic MR and spiral CT in three cases. Clin Imaging. 2004;28:349–52.

    Article  PubMed  Google Scholar 

  98. Mortele KJ, Mortele B, Silverman SG. CT features of the accessory spleen. Am J Roentgenol. 2004;183:1653–7.

    Article  Google Scholar 

  99. Spencer LA, Spizarny DL, Williams TR. Imaging features of intrapancreatic accessory spleen. Br J Radiol. 2010;83:668–73.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  100. Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc. 2005;62:728–36; quiz 751, 753.

    Article  PubMed  Google Scholar 

  101. Chari ST, Kloeppel G, Zhang L, Notohara K, Lerch MM, Shimosegawa T. Histopathologic and clinical subtypes of autoimmune pancreatitis: the Honolulu consensus document. Pancreas. 2010;39:549–54.

    Article  CAS  PubMed  Google Scholar 

  102. Kamisawa T, Chari ST, Giday SA, Kim MH, Chung JB, Lee KT, Werner J, Bergmann F, Lerch MM, Mayerle J, Pickartz T, Lohr M, Schneider A, Frulloni L, Webster GJ, Reddy DN, Liao WC, Wang HP, Okazaki K, Shimosegawa T, Kloeppel G, Go VL. Clinical profile of autoimmune pancreatitis and its histological subtypes: an international multicenter survey. Pancreas. 2011;40:809–14.

    Article  CAS  PubMed  Google Scholar 

  103. Maker AV, Lee LS, Raut CP, Clancy TE, Swanson RS. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol. 2008;15:3187–92.

    Article  PubMed  Google Scholar 

  104. Kitano M, Sakamoto H, Kudo M. Contrast-enhanced endoscopic ultrasound. Dig Endosc. 2014;26 Suppl 1:79–85.

    Article  PubMed  Google Scholar 

  105. Park JS, Kim HK, Bang BW, Kim SG, Jeong S, Lee DH. Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses. World J Gastroenterol. 2014;20:518–24.

    Article  PubMed Central  PubMed  Google Scholar 

  106. Cirillo F, Falconi M, Bettini R. Clinical manifestations and therapeutic management of hyperfunctioning endocrine tumors. In: Procacci C, Megibow AJ, editors. Imaging of the pancreas: cystic and rare tumors. Berlin; New York: Springer; 2003. p. 141–52.

    Chapter  Google Scholar 

  107. Zamboni GFN, Hruban RH, et al. Mucinous cystic neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, et al., editors. World Health Organization classification of tumours of the digestive system. 4th ed. Lyon (France): IARC; 2010. p. 300–3.

    Google Scholar 

  108. Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.

    Article  PubMed  Google Scholar 

  109. Wu BU, Sampath K, Berberian CE, Kwok KK, Lim BS, Kao KT, Giap AQ, Kosco AE, Akmal YM, Difronzo AL, Yu W, Ngor EW. Prediction of malignancy in cystic neoplasms of the pancreas: a population-based cohort study. Am J Gastroenterol. 2014;109:121–9. quiz 130.

    Article  PubMed  Google Scholar 

  110. Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol. 2007;102:2339–49.

    Article  PubMed  Google Scholar 

  111. Grobmyer SR, Cance WG, Copeland EM, Vogel SB, Hochwald SN. Is there an indication for initial conservative management of pancreatic cystic lesions? J Surg Oncol. 2009;100:372–4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael Bartel M.D. & Milena Di Leo M.D.

  2. Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Massimo Raimondo M.D.

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  1. Michael Bartel M.D.
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  2. Milena Di Leo M.D.
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  3. Massimo Raimondo M.D.
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Correspondence to Massimo Raimondo M.D. .

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Editors and Affiliations

  1. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Mihir S. Wagh

  2. Division of Gastroenterology, University of Florida, Gainesville, Florida, USA

    Peter V. Draganov

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Bartel, M., Di Leo, M., Raimondo, M. (2016). Differential Diagnosis and Diagnostic Evaluation Algorithm. In: Wagh, M., Draganov, P. (eds) Pancreatic Masses. Springer, Cham. https://doi.org/10.1007/978-3-319-19677-0_16

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