Reappraising imaging features of pancreatic acinar cystic transformation: be aware of differential diagnoses.
Acinar cell cystadenoma
Diagnostic imaging
Exocrine pancreas
Pancreatic acinar cystic transformation
Pancreatic cyst
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
11 Jun 2024
11 Jun 2024
Historique:
received:
23
02
2024
accepted:
22
04
2024
revised:
23
02
2024
medline:
12
6
2024
pubmed:
12
6
2024
entrez:
11
6
2024
Statut:
aheadofprint
Résumé
Imaging features of pancreatic acinar cystic transformation (ACT) have been published. We aimed to describe the clinical and radiological characteristics of patients with a presumed pancreatic ACT diagnosis, reappraising the value of these published imaging criteria. Single-center retrospective study (2003-2021) of consecutive patients with a presumed diagnosis of ACT as suggested by the local expert multidisciplinary case review board. Patients without available imaging (CT or MRI) for review were excluded. Patients were classified into "certain" ACT (if ≥ 2 imaging criteria and no differential diagnosis) or "uncertain" ACT (if ≥ 1 imaging criteria and suggested differential diagnoses). Sixty-four patients (35 males, [55%]) were included. ACT was considered "certain" for 34 patients (53%) and "uncertain" for 30 patients (47%). The number of ACT criteria did not differ between groups, with 91.2% of patients with ≥ 3 ACT imaging criteria in the "certain" group vs 93.3% in the "uncertain" group (p = 0.88). In the "uncertain" group, the main suggested differentials were branch-duct intraductal papillary mucinous neoplasm (18/30 patients, 60%), calcifying chronic pancreatitis (8/30 patients, 27%), both (three patients, 10%) and serous cystadenoma (one patient, 3%). Calcifications were significantly more frequent in the "uncertain" group (89% vs 63% in the "certain" group, p = 0.02). Published ACT imaging criteria are frequently associated with features suggesting differential diagnoses. They appear insufficient to reach a final diagnosis in a subset of patients. ACT displays a heterogeneous morphological imaging presentation challenging the non-invasive diagnostic work-up. Physicians' and radiologists' awareness of this entity is important to better understand its natural history and improve non-invasive diagnostic criteria. The criteria to help diagnose ACT are frequently associated with features suggestive of differentials. The main alternatives suggested when ACT diagnosis was "uncertain" were branch-duct intraductal papillary mucinous neoplasm and calcifying chronic pancreatitis. Published ACT diagnostic imaging criteria can be insufficient for a definite non-invasive diagnosis.
Identifiants
pubmed: 38862730
doi: 10.1007/s00330-024-10823-3
pii: 10.1007/s00330-024-10823-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to European Society of Radiology.
Références
Klöppel G (2000) Pseudocysts and other non-neoplastic cysts of the pancreas. Semin Diagn Pathol 17:7–15
pubmed: 10721803
Couvelard A, Terris B, Hammel P et al (2002) [Acinar cystic transformation of the pancreas (or acinar cell cystadenoma), a rare and recently described entity]. Ann Pathol 22:397–400
pubmed: 12483157
Zamboni G, Terris B, Scarpa A et al (2002) Acinar cell cystadenoma of the pancreas: A new entity? Am J Surg Pathol 26:698–704. https://doi.org/10.1097/00000478-200206000-00002
doi: 10.1097/00000478-200206000-00002
pubmed: 12023573
Rift CV, Hasselby JP, Hansen CP, Federspiel B (2020) Acinar cystic transformation of the pancreas: report of a case and a review of the literature. Pathol Res Pract 216:152928. https://doi.org/10.1016/j.prp.2020.152928
doi: 10.1016/j.prp.2020.152928
pubmed: 32204924
Luchini C, Mattiolo P, Basturk O et al (2023) Acinar cystic transformation of the pancreas: histomorphology and molecular analysis to unravel its heterogeneous nature. Am J Surg Pathol. https://doi.org/10.1097/PAS.0000000000002017
Khor TS, Badizadegan K, Ferrone C et al (2012) Acinar cystadenoma of the pancreas: a clinicopathologic study of 10 cases including multilocular lesions with mural nodules. Am J Surg Pathol 36:1579–1591. https://doi.org/10.1097/PAS.0b013e318265fa4b
doi: 10.1097/PAS.0b013e318265fa4b
pubmed: 23060352
Albores-Saavedra J (2002) Acinar cystadenoma of the pancreas: a previously undescribed tumor. Ann Diagn Pathol 6:113–115. https://doi.org/10.1053/adpa.2002.32379
doi: 10.1053/adpa.2002.32379
pubmed: 12004359
Wen X, Bandovic J (2020) Fifteen-year follow-up of a patient with acinar cystic transformation of the pancreas and literature review. Case Rep Pathol 2020:8847550. https://doi.org/10.1155/2020/8847550
doi: 10.1155/2020/8847550
pubmed: 33425418
pmcid: 7781703
Nagtegaal ID, Odze RD, Klimstra D et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76:182–188. https://doi.org/10.1111/his.13975
doi: 10.1111/his.13975
pubmed: 31433515
Bergmann F, Aulmann S, Welsch T et al (2014) Molecular analysis of pancreatic acinar cell cystadenomas: evidence of a non-neoplastic nature. Oncol Lett 8:852–858. https://doi.org/10.3892/ol.2014.2163
doi: 10.3892/ol.2014.2163
pubmed: 25009661
pmcid: 4081433
Mattiolo P, Wang H, Basturk O et al (2023) Comprehensive characterisation of acinar cystic transformation of the pancreas: a systematic review. J Clin Pathol 76:740–746. https://doi.org/10.1136/jcp-2023-209103
Gumus M, Ugras S, Algin O, Gundogdu H (2011) Acinar cell cystadenoma (acinar cystic transformation) of the pancreas: the radiologic-pathologic features. Korean J Radiol 12:129–134. https://doi.org/10.3348/kjr.2011.12.1.129
doi: 10.3348/kjr.2011.12.1.129
pubmed: 21228949
pmcid: 3017877
Delavaud C, d’Assignies G, Cros J et al (2014) CT and MR imaging of multilocular acinar cell cystadenoma: comparison with branch duct intraductal papillary mucinous neoplasia (IPMNs). Eur Radiol 24:2128–2136. https://doi.org/10.1007/s00330-014-3248-0
doi: 10.1007/s00330-014-3248-0
pubmed: 24895037
Kromrey M-L, Bülow R, Hübner J et al (2018) Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut 67:138–145. https://doi.org/10.1136/gutjnl-2016-313127
doi: 10.1136/gutjnl-2016-313127
pubmed: 28877981
Laurent L, Vullierme M-P, Rebours V et al (2017) Estimation of the prevalence of intraductal papillary mucinous neoplasm of the pancreas in the French population through patients waiting for liver transplantation. United European Gastroenterol J 5:499–503. https://doi.org/10.1177/2050640616664842
doi: 10.1177/2050640616664842
pubmed: 28588880
Salvia R, Burelli A, Nepi A et al (2023) Pancreatic cystic neoplasms: Still high rates of preoperative misdiagnosis in the guidelines and endoscopic ultrasound era. Surgery S0039-6060:00444–0. https://doi.org/10.1016/j.surg.2023.07.016
doi: 10.1016/j.surg.2023.07.016
Alkhateeb MA, Boqari D, Mansi NK (2020) Pancreatic acinar cystadenoma in a background of diffuse multifocal pancreatic cystic lesions: a case report. Int J Surg Case Rep 73:223–227. https://doi.org/10.1016/j.ijscr.2020.07.026
doi: 10.1016/j.ijscr.2020.07.026
pubmed: 32712551
pmcid: 7390793
Guo L, Qian Y (2023) Diffuse acinar cystic transformation of the pancreas-a rare case in a young male patient. Rev Esp Enferm Dig. https://doi.org/10.17235/reed.2023.9897/2023
Lee JH, Jung SJ, Park YH et al (2021) Pancreatic acinar cell cystadenoma mimicking pancreatic serous cystadenoma. Korean J Gastroenterol 78:138–143. https://doi.org/10.4166/kjg.2021.044
doi: 10.4166/kjg.2021.044
pubmed: 34446637
Zhang X, Zhu H, Yang X et al (2017) Post-obstructive cyst formation in pancreas and cystic acinar transformation: Are they same? Pathol Res Pract 213:997–1001. https://doi.org/10.1016/j.prp.2017.03.013
doi: 10.1016/j.prp.2017.03.013
pubmed: 28599853
Tanaka H, Hatsuno T, Kinoshita M et al (2016) A resected case of symptomatic acinar cell cystadenoma of the pancreas displacing the main pancreatic duct. Surg Case Rep 2:39. https://doi.org/10.1186/s40792-016-0166-1
doi: 10.1186/s40792-016-0166-1
pubmed: 27108123
pmcid: 4842199
Scott BB, Price TP, Callahan ZM et al (2016) Intraductal papillary mucinous neoplasm of the pancreas arising in the setting of an intermixed acinar cell cystadenoma of the pancreas: report of a rare case. Case Rep Pancreat Cancer 2:75–78. https://doi.org/10.1089/crpc.2016.0018
doi: 10.1089/crpc.2016.0018
pubmed: 30631822
pmcid: 6319694