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Nonneoplastic Solid Mass Lesions of the Pancreas

  • Simon Sung
  • Rema RaoEmail author
Chapter
Part of the Essentials in Cytopathology book series (EICP, volume 28)

Abstract

Nonneoplastic solid mass-like lesions can pose unique diagnostic challenges. Benign lesions presenting as a solid mass on imaging are often sampled with endoscopic ultrasound fine-needle aspiration (EUS-FNA) biopsy to rule out malignancy. Imaging characteristics can be nonspecific and/or misleading. It is important to recognize key cytomorphologic features and avoid pitfalls in the lesions presented below. Some of these lesions, particularly autoimmune pancreatitis, can mimic carcinoma on both radiology and cytology. There are important clues on the slides as well as in the clinical history and available ancillary studies that can help in distinguishing these lesions. This chapter covers those nonneoplastic lesions that need to be considered when a solid mass-like lesion is encountered in the pancreas or peripancreatic tissue.

Keywords

Chronic pancreatitis Autoimmune pancreatitis Paraduodenal/groove pancreatitis Accessory spleen Intrapancreatic lymph node Sarcoidosis 

References

  1. 1.
    Adsay NV, Basturk O, Klimstra DS, Kloppel G. Pancreatic pseudotumors: non-neoplastic solid lesions of the pancreas that clinically mimic pancreas cancer. Semin Diagn Pathol. 2004;21(4):260–7.CrossRefGoogle Scholar
  2. 2.
    Wick MR, Tazelaar HD. Pseudoneoplastic lesions: general considerations. Arch Pathol Lab Med. 2010;134(3):351–61.PubMedGoogle Scholar
  3. 3.
    Okun SD, Lewin DN. Non-neoplastic pancreatic lesions that may mimic malignancy. Semin Diagn Pathol. 2016;33(1):31–42.CrossRefGoogle Scholar
  4. 4.
    Frampas E, Morla O, Regenet N, Eugene T, Dupas B, Meurette G. A solid pancreatic mass: tumour or inflammation? Diagn Interv Imaging. 2013;94(7–8):741–55.CrossRefGoogle Scholar
  5. 5.
    Anaizi A, Hart PA, Conwell DL. Diagnosing chronic pancreatitis. Dig Dis Sci. 2017;62(7):1713–20.CrossRefGoogle Scholar
  6. 6.
    Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nat Rev Dis Primers. 2017;3:17060.CrossRefGoogle Scholar
  7. 7.
    Uc A, Fishman DS. Pancreatic disorders. Pediatr Clin N Am. 2017;64(3):685–706.CrossRefGoogle Scholar
  8. 8.
    Tirkes T. Chronic pancreatitis: what the clinician wants to know from MR imaging. Magn Reson Imaging Clin N Am. 2018;26(3):451–61.CrossRefGoogle Scholar
  9. 9.
    Patel V, Willingham F. The management of chronic pancreatitis. Med Clin North Am. 2019;103(1):153–62.CrossRefGoogle Scholar
  10. 10.
    Stelow EB, Bardales RH, Lai R, Mallery S, Linzie BM, Crary GS, et al. The cytological spectrum of chronic pancreatitis. Diagn Cytopathol. 2005;32(2):65–9.CrossRefGoogle Scholar
  11. 11.
    Samad A, Attam R, Pambuccian SE. Calcifications in an endoscopic ultrasound-guided fine-needle aspirate of chronic pancreatitis. Diagn Cytopathol. 2013;41(12):1081–5.CrossRefGoogle Scholar
  12. 12.
    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):1119–27.CrossRefGoogle Scholar
  13. 13.
    Hardacre JM, Iacobuzio-Donahue CA, Sohn TA, Abraham SC, Yeo CJ, Lillemoe KD, et al. Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis. Ann Surg. 2003;237(6):853–8; discussion 8-9.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Nishimori I, Tamakoshi A, Otsuki M. Research Committee on Intractable Diseases of the Pancreas MoHL, Welfare of J. Prevalence of autoimmune pancreatitis in Japan from a nationwide survey in 2002. J Gastroenterol. 2007;42(Suppl 18):6–8.CrossRefGoogle Scholar
  15. 15.
    Weber SM, Cubukcu-Dimopulo O, Palesty JA, Suriawinata A, Klimstra D, Brennan MF, et al. Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg. 2003;7(1):129–37; discussion 37-9.CrossRefGoogle Scholar
  16. 16.
    Zamboni G, Luttges J, Capelli P, Frulloni L, Cavallini G, Pederzoli 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. 2004;445(6):552–63.CrossRefGoogle Scholar
  17. 17.
    Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40(3):352–8.CrossRefGoogle Scholar
  18. 18.
    Adler JM, Gardner TB. Fine-needle aspiration for autoimmune pancreatitis-not ready for prime time. Gastrointest Endosc. 2016;84(2):249–51.CrossRefGoogle Scholar
  19. 19.
    Ishikawa T, Itoh A, Kawashima H, Ohno E, Matsubara H, Itoh Y, et al. Endoscopic ultrasound-guided fine needle aspiration in the differentiation of type 1 and type 2 autoimmune pancreatitis. World J Gastroenterol. 2012;18(29):3883–8.CrossRefGoogle Scholar
  20. 20.
    Kanno A, Ishida K, Hamada S, Fujishima F, Unno J, Kume K, et al. Diagnosis of autoimmune pancreatitis by EUS-FNA by using a 22-gauge needle based on the International Consensus Diagnostic Criteria. Gastrointest Endosc. 2012;76(3):594–602.CrossRefGoogle Scholar
  21. 21.
    Majumder S, Chari ST. EUS-guided FNA for diagnosing autoimmune pancreatitis: Does it enhance existing consensus criteria? Gastrointest Endosc. 2016;84(5):805–7.CrossRefGoogle Scholar
  22. 22.
    Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas”, “para-duodenal wall cyst”, and “groove pancreatitis”. Semin Diagn Pathol. 2004;21(4):247–54.CrossRefGoogle Scholar
  23. 23.
    Raman SP, Salaria SN, Hruban RH, Fishman EK. Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation. AJR Am J Roentgenol. 2013;201(1):W29–39.CrossRefGoogle Scholar
  24. 24.
    Shin LK, Jeffrey RB, Pai RK, Raman SP, Fishman EK, Olcott EW. Multidetector CT imaging of the pancreatic groove: differentiating carcinomas from paraduodenal pancreatitis. Clin Imaging. 2016;40(6):1246–52.CrossRefGoogle Scholar
  25. 25.
    Mittal PK, Harri P, Nandwana S, Moreno CC, Muraki T, Adsay V, et al. Paraduodenal pancreatitis: benign and malignant mimics at MRI. Abdom Radiol (NY). 2017;42(11):2652–74.CrossRefGoogle Scholar
  26. 26.
    Brosens LA, Leguit RJ, Vleggaar FP, Veldhuis WB, van Leeuwen MS, Offerhaus GJ. EUS-guided FNA cytology diagnosis of paraduodenal pancreatitis (groove pancreatitis) with numerous giant cells: conservative management allowed by cytological and radiological correlation. Cytopathology. 2015;26(2):122–5.CrossRefGoogle Scholar
  27. 27.
    Li BQ, Xu XQ, Guo JC. Intrapancreatic accessory spleen: a diagnostic dilemma. HPB (Oxford). 2018;20(11):1004–11.CrossRefGoogle Scholar
  28. 28.
    Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, et al. Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol. 2008;9(2):162–74.CrossRefGoogle Scholar
  29. 29.
    Movitz D. Accessory spleens and experimental splenosis. Principles of growth. Chic Med Sch Q. 1967;26(4):183–7.PubMedGoogle Scholar
  30. 30.
    Dodds WJ, Taylor AJ, Erickson SJ, Stewart ET, Lawson TL. Radiologic imaging of splenic anomalies. AJR Am J Roentgenol. 1990;155(4):805–10.CrossRefGoogle Scholar
  31. 31.
    Ding Q, Ren Z, Wang J, Ma X, Zhang J, Sun G, et al. Intrapancreatic accessory spleen: evaluation with CT and MRI. Exp Ther Med. 2018;16(4):3623–31.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Bhutiani N, Egger ME, Doughtie CA, Burkardt ES, Scoggins CR, Martin RC 2nd, et al. Intrapancreatic accessory spleen (IPAS): a single-institution experience and review of the literature. Am J Surg. 2017;213(4):816–20.CrossRefGoogle Scholar
  33. 33.
    Tummala Md P, Rao Md S, Agarwal Md B. 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.CrossRefGoogle Scholar
  34. 34.
    Prasse A. The diagnosis, differential diagnosis, and treatment of sarcoidosis. Dtsch Arztebl Int. 2016;113(33–34):565–74.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Low G, Panu A, Millo N, Leen E. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 2011;31(4):993–1015.CrossRefGoogle Scholar
  36. 36.
    Seki K, Sakatani M, Tachibana T. Extrapulmonary lesions of sarcoidosis. Nihon Kyobu Shikkan Gakkai Zasshi. 1990;28(1):74–9.PubMedGoogle Scholar
  37. 37.
    Soyer P, Gottlieb L, Bluemke DA, Fishman E. Sarcoidosis of the pancreas mimicking pancreatic cancer: CT features. Eur J Radiol. 1994;19(1):32–3.CrossRefGoogle Scholar
  38. 38.
    Bonhomme A, Dhadamus A, De Bie P, Van Hoe L, Baert AL. Pancreatic involvement in systemic sarcoidosis: CT findings. J Belg Radiol 1997;80(3):116–117.PubMedGoogle Scholar
  39. 39.
    Shukla M, Hassan MF, Toor V, Kaur J, Solomon C, Cohen H. Symptomatic pancreatic sarcoidosis. Case report and review of literature. JOP. 2007;8(6):770–4.PubMedGoogle Scholar
  40. 40.
    Wijkstrom M, Bechara RI, Sarmiento JM. A rare nonmalignant mass of the pancreas: case report and review of pancreatic sarcoidosis. Am Surg. 2010;76(1):79–84.PubMedGoogle Scholar
  41. 41.
    Delgado-Bolton RC, Arias Navalon JA, Rodriguez Alfonso B, Delgado-Bolton AN, Perez-Castejon MJ, Sanchez-Escribano R, et al. Pancreatic involvement detected with (18)F-FDG PET/CT in disseminated sarcoidosis. Rev Esp Med Nucl. 2011;30(1):29–32.CrossRefGoogle Scholar
  42. 42.
    Zhang LN, Xue QL, Wang JX. Mimicking pancreatic malignancy: a systemic sarcoidosis. Ann Saudi Med. 2014;34(1):70–4.CrossRefGoogle Scholar
  43. 43.
    Mony S, Patil PD, English R, Das A, Culver DA, Panchabhai TS. A rare presentation of sarcoidosis as a pancreatic head mass. Case Rep Pulmonol. 2017;2017:7037162.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Matsuura S, Mochizuka Y, Oishi K, Miyashita K, Naoi H, Mochizuki E, et al. Sarcoidosis with pancreatic mass, endobronchial nodules, and miliary opacities in the lung. Intern Med. 2017;56(22):3083–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Columbia University Medical Center-New York Presbyterian, Department of Pathology and Cell BiologyNew YorkUSA
  2. 2.Department of Pathology and Laboratory MedicineWeill-Cornell Medicine, New York Presbyterian HospitalNew YorkUSA

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