Imaging and Pathology of Pancreatic Neoplasms: A Pictorial Atlas

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The second edition of this atlas focuses on imaging methods and techniques, new diagnostic concepts and therapeutic approaches in management of pancreatic neoplasms. Although interest in pancreatic pathology is very high in the radiological and gastroenterological communities, less is known about it than about, for example, liver pathology. Diagnosis depends on the structure of the pancreatic lesion, which can be directly visualized in US, CT or MR images.

The book’s focus is very much on the imaging and pathological appearances, with most of the text concentrated at the beginning of the book followed by images gallery. A comprehensive overview is provided of typical and atypical presentations and diverse aspects of common and rare pancreatic tumors, including ductal adenocarcinomas with dedicated chapter to ductal adenocarcinoma downstaging, neuroendocrine neoplasms, cystic pancreatic neoplasms and intraductal papillary mucinous neoplasms.

The Verona “Pancreas Centre,” the first institute of its kind in Italy and one of very few in the world, pursues an interdisciplinary approach to treating the problems of this organ, focusing on the patient, on research, and on teaching. A dedicated center that can look back on 40 years of tradition, many of its respected specialists have made essential contributions in surgery, gastroenterology, oncology, pathology, and radiology.

Given its scope, this atlas will be an invaluable asset, helping radiologists understand the underlying pathology and helping pancreatic pathologists understand the imaging translation.

Author(s): Mirko D'Onofrio, Paola Capelli, Paolo Pederzoli
Edition: 2
Publisher: Springer
Year: 2022

Language: English
Pages: 546
City: Cham

Foreword to the Second Edition
Acknowledgments
Contents
Ductal Adenocarcinoma
Introduction
Pathology
Macroscopy
Microscopy
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Clinical Presentation
Symptomatic
Asymptomatic
Behavior
Typical
Atypical
Variants
Pathology
Adenosquamous Carcinoma (ASC)
Colloid Carcinoma (Mucinous Noncystic Carcinoma)
Undifferentiated Carcinoma (Anaplastic Carcinoma)
Medullary Carcinoma
Cystic Aspect at Imaging
Isodense Mass
Pitfalls and Errors
Imaging-Pathologic Correlation
Differential Diagnosis
Image Gallery
References
Ductal Adenocarcinoma: Downstaging
Introduction
Resectability
Neoadjuvant Therapy
Radiological Evaluation After Neoadjuvant Chemoradiotherapy
Conclusions
Image Gallery
References
Neuroendocrine Neoplasms
Introduction
Pathology
Macroscopy
Microscopy
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Clinical Presentation
Asymptomatic
Symptomatic
Behavior
Typical
Atypical
Variants
Macroscopy
Fibrotic
Cystic
Involvement of the Main Pancreatic Duct
Black and Yellow
Lipid Rich
Microscopy
Fibrotic
Cystic
Pitfalls and Errors
Imaging-Pathologic Correlation
Image Gallery
References
Mimickers of Pancreatic Tumor
Introduction
Inflammatory Pancreatic Conditions
Chronic Pancreatitis
Paraduodenal Pancreatitis
Autoimmune Pancreatitis
Inflammatory Pseudotumor
Anatomic Pancreatic Variants (See First Edition)
Fatty Replacement
Rare Non-neoplastic Pancreatic Diseases
Sarcoidosis
Castleman Disease
Tuberculosis
Peripancreatic Structures
Lymph Nodes
Vessels
Organs
Image Gallery
References
Intraductal Papillary Mucinous Neoplasm (IPMN)
Introduction
Pathology
Macroscopy
Microscopy
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
PET
EUS
Clinical Presentation
Asymptomatic
Symptomatic
Behavior
Typical
Atypical
Variants
Pathology
Pitfalls and Errors
Imaging-Pathologic Correlation
Differential Diagnosis
Pathologic Differential Diagnosis
Image Gallery
References
Serous Neoplasms
Introduction
Pathology
Macroscopy
Microscopy
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Clinical Presentation
Asymptomatic
Symptomatic
Behavior
Typical
Atypical
Variants
Macrocystic Serous Cystic Neoplasms
Solid Serous Neoplasms
Von Hippel–Lindau (VHL)-Associated Serous Cystic Neoplasms
Pitfalls and Errors
Imaging-Pathologic Correlation
Differential Diagnosis
Image Gallery
References
Mucinous Neoplasms
Introduction
Pathology
Macroscopy
Microscopy
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Clinical Presentation
Asymptomatic
Symptomatic
Behavior
Typical
Atypical
Variants
Pitfalls and Errors
Imaging-Pathologic Correlation
Differential Diagnosis
Image Gallery
References
Pseudocysts and Other Cystic Lesions
Introduction
Pseudocysts and Fluid Collections in Pancreatitis
Acute Peripancreatic Fluid Collection (APFC)
Pseudocyst
Acute Necrotic Collection (ANC)
Walled-off Necrosis (WON)
Other Non-neoplastic Cystic Lesions
Paraduodenal Pancreatitis (PDP)
Duodenal Cystic Duplication
Mesenteric Pseudocyst
Retroperitoneal Lymphocele
Rare Neoplastic Cystic Pancreatic Lesions
Solid Pseudopapillary Neoplasm (SPN)
Pancreatic Cystic Lymphangioma
Lymphoepithelial Cyst
Mesothelial Cyst
Image Gallery
References
Secondary Tumors and Lymphoma
Introduction
Pathology
Metastases
Primary Pancreatic Lymphoma
Macroscopy
Metastases
Primary Pancreatic Lymphoma
Microscopy
Metastases
Primary Pancreatic Lymphoma
Imaging
Metastases
Primary Pancreatic Lymphoma
Clinical Presentation
Metastases
Primary Pancreatic Lymphoma
Behavior
Typical
Metastases
Primary Pancreatic Lymphoma
Atypical
Variants
Metastases
Primary Pancreatic Lymphoma
Pitfalls and Errors
Metastases
Primary Pancreatic Lymphoma
Imaging–Pathologic Correlation
Metastases
Primary Pancreatic Lymphoma
Differential Diagnosis
Metastases
Primary Pancreatic Lymphoma
Image Gallery
References
Uncommon Presentations of Pancreatic Neoplasms, Rare Neoplasms, and Peripancreatic Masses
Ductal Adenocarcinoma
Isodense Appearance
Cystic Appearance
Acute Pancreatitis
Pancreatitis-Like Appearance
Neuroendocrine Neoplasms
Hypoenhancing Neuroendocrine Neoplasms
Intravascular Growth
Cystic
Calcified
Pancreatic Carcinoid
Serous Cystadenoma
Macrocystic and Unilocular
Pseudo-Solid Appearance
“Giant” SCA
Mucinous Cystic Neoplasms
Uncommon Site and Gender
Disepithelized Walls
Intraductal Papillary Mucinous Neoplasms
Pan-Ductal-Ectasia
“Colonizing” Appearance
Solid Pseudopapillary Neoplasms
Small
Rare Pancreatic Neoplasms
Peripancreatic Masses
References
Pancreatic Surgery and Post-Operative Complications
Types of Pancreatic Surgery
Pancreaticoduodenectomy
Distal Pancreatectomy
Total Pancreatectomy
Parenchyma-Sparing Resections
Vascular Resection During Pancreatic Resection
Post-Operative Complications
Post-Operative Pancreatic Fistula
Post-Operative Biliary Fistula
Post-Pancreatectomy Hemorrhage
Delayed Gastric Emptying
Post-Operative Pancreatitis
References
Imaging Methods for Pancreatic Neoplasms
Introduction
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Future Prospective in Pancreatic Imaging
Image Gallery
References
Advanced Imaging of Pancreatic Neoplasms
Introduction
Computed Tomography
Multidetector CT vs Dual-Energy CT
CT Perfusion
Magnetic Resonance
T2-Weighted Imaging (T2WI)
Non-cartesian T2WI
Reduce Field of View Imaging
Artificial Intelligence Enhanced T2WI
T1-Weighted Imaging (T1WI) and Dynamic Contrast-Enhanced Imaging (DCE)
Fat Saturation Techniques
Respiratory Artefact Reduction
Pancreatic Neoplasia MRI Perfusion
Diffusion-Weighted Imaging (DWI)
Fusion Between T2WI and DWI
Computed DWI
Simultaneous Multi-Slice (SMS) Acquisition
Intra-Voxel Incoherent Motion (IVIM) and Diffusion Kurtosis Imaging (DKI)
Magnetic Resonance Cholangiopancreatography (MRCP)
Radiomics and Artificial Intelligence Applied to Pancreatic Neoplasm
References
Elastography and New Ultrasound Techniques
Introduction
Techniques, Methods, and Approaches
Basic Principles of Elastography
Strain Elastography (Quasi-Static Strain Imaging)
Region of Interest
How to Achieve the Best Image Quality for Elastography?
Shear Wave Elastography
Acoustic Radiation Force Impulse (ARFI)
Safety Considerations
Limitations
Clinical Applications
Introduction Into the Pancreas
Introduction into Pancreatic Elastography
Endoscopic Ultrasound (EUS) Elastography
Interpretation
Limitations and Artifacts
Examination Technique
Normal Pancreas
Acute Pancreatitis
Chronic Pancreatitis
Focal Pancreatic Masses
Neuroendocrine Tumors
Cystic Pancreatic Tumors
Recommendations [6]
Lymph Nodes
Recommendations [6]
Gastrointestinal Tract
Recommended Uses and Indications
Hepatobiliary System
Future Applications
Other New Ultrasound Techniques
Compound Imaging
Doppler Techniques
Perfusion Imaging
Indications
Transplant Medicine
Three-Dimensional (3D) Sonography
Fusion
Conclusion
References
Percutaneous Interventional Procedures in Pancreatic Cancer
Percutaneous Interventional Procedures Guidance
Pancreatic Cancer Biopsy
Tumor Ablation
Conclusion
Image Gallery
References
New Diagnostic and Interventional Endoscopic Techniques
Modern Diagnostic Tools of Endoscopic Ultrasound in Detection and Differentiation of Pancreatic Neoplasms
Contrast-Enhanced Endoscopic Ultrasound
Elastography
Three-Dimensional Endoscopic Ultrasound
Endoscopic Fine Needle Puncture in the Diagnostic Setup
Interventional Endoscopic Ultrasound
Tumor Destructive Methods
Therapeutic Endoscopic Ultrasound
Conclusion
References