ARRS 2022 Abstracts

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E1974. Pancreatic Diffuse Enlargement: Non-Neoplastic and Neoplastic Lesions
Authors
  1. Victor Polanco Amesquita; Hospital de Agudos Dr. Cosme Argerich
  2. German Espil; Hospital de Agudos Dr. Cosme Argerich
  3. Victor Larrañaga; Hospital de Agudos Dr. Cosme Argerich
  4. Mariana Bello; Hospital de Agudos Dr. Cosme Argerich
  5. Jhisel Lazcano Soliz; Hospital de Agudos Dr. Cosme Argerich
  6. Shigeru Kozima; Hospital de Agudos Dr. Cosme Argerich
  7. Hugo Altieri Mohedano; Hospital de Agudos Dr. Cosme Argerich
Background
The pancreatic diseases associated with diffuse enlargement encompass a large histological variety of lesions. Its evaluation can be challenging, and it is important to differentiate between benign and malignant lesions.

Educational Goals / Teaching Points
This exhibit aims to review imaging features of diffuse pancreatic lesions using a case-based approach, with clinical information and diagnostic clues needed to aid in their proper diagnosis and management; and learn how to discriminate between neoplastic and non-neoplastic lesions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes the following key issues. Non-neoplastic Autoimmune pancreatitis (three forms of presentation: diffuse, focal, or multifocal involvement); acute pancreatitis; diffuse parenchymal enlargement associated with peripancreatic fat stranding (two subtypes: revised Atlanta classification); lipomatous pseudohypertrophy of the pancreas, which is a rare benign entity characterized by focal or diffuse enlargement of the pancreas; and Von Hippel–Lindau (VHL) disease. Pancreatic involvement in VHL disease includes simple pancreatic cysts (50–91%), serous microcystic adenomas (12%), neuroendocrine tumors (5–17%) and rarely adenocarcinomas. The exhibit also includes neoplastic diffuse pancreatic neuroendocrine tumor (typically hypervascular lesion, small well-defined [functional] or larger [nonfunctional]; pancreatic lymphoma (30% of cases of NHL, usually from contiguous nodal extension; diffuse solid pseudopapillary tumor (women, [second to fourth decades], low malignant potential); and extraosseous multiple myeloma. Autopsy studies show involvement of pancreas is 4-17%. Patients are often asymptomatic but can present with obstructive jaundice. Diffuse pancreatic ductal adenocarcinoma (location: 79% body, tail 21%; whole pancreas involvement; enhancing “capsule” is present in 93% of cases) and diffuse pancreatic metastases are also discussed. Most cases are solitary, and multifocal involvement is not unusual. Diffuse involvement is rare.

Conclusion
A variety of pancreatic diseases associated with diffuse enlargement have variable characteristic imaging features. Differentiating pancreatic benign lesions from malignancy remains the primary diagnostic challenge, therefore familiarity with their clinical and radiologic manifestations helps the radiologist in formulating an accurate differential diagnosis.