Unusual Masses of the Pancreas to Be Aware of

Abstract

This paper aims at emphasizing the difficulty in assessing preoperatively the diagnosis of solid masses of the pancreas whatever the initial clinical presentation may be. We illustrate our purpose describing consecutive cases of pancreatic masses of the pancreas we recently had and who were followed according to the internal guidelines of investigation of our referral hospital. Whereas malignant tumors of the pancreas represent the vast majority of solid tumors of the pancreas, other diagnoses must be evoked. We report three cases of pancreatic solid masses that were explored by endoscopic ultrasonography coupled with fine needle aspiration, a method universally considered to be both reliable and accurate but which failed to assess definitive diagnosis due to both cytological pitfalls and sampling error.

Fig. 1

a CT scan showing a 4 × 2 cm hypodense mass of the pancreatic tail. b EUS showing a heterogenous hypoechoic mass of the tail of the pancreas using a sectorial endoscope at the time of FNA.

Fig. 2

a CT scan with a large corporeal hypodense mass of the pancreas with fine delineated hyperechoic wall. b The mass seen at EUS was hypoechoic with a strong heterogenous content. c PET-CT demonstrated a huge hypermetabolic state of the pancreatic mass.

Fig. 3

a CT showed a well-delineated mass of the pancreatic tail without upstream ductular dilatation. b A small homogenous mass of the pancreas was demonstrated by EUS at the time of FNA. Note that the mass was very well delineated. c Octreoscan identified a hyperintense spot located in the tail of the pancreas when compared to the spleen.