Paraduodenal Pancreatitis: Imaging and Pathologic Correlation of 47 Cases Elucidates Distinct Subtypes and the Factors Involved in its Etiopathogenesis

Takashi Muraki, Grace E. Kim, Michelle D. Reid, Pardeep Kumar Mittal, Gabriela Bedolla, Bahar Memis, Burcin Pehlivanoglu, Alexa Freedman, Ipek Erbarut Seven, Hyejeong Choi, David Kooby, Shishir K. Maithel, Juan M. Sarmiento, Alyssa Krasinskas, Volkan Adsay

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Clinicopathologic characteristics of paraduodenal (groove) pancreatitis (PDP) remain to be fully unraveled. In this study, 47 PDPs with preoperative enhanced images available were subjected to detailed comparative analysis in conjunction with pathologic findings. PDP were predominantly in males (3:1) with a mean age of 50 years, and 60% had a preoperative diagnosis of cancer. Mean lesional size was 3.1 cm. Three distinct subtypes were identified by imaging. Solid-tumoral (type-1) with groove-predominant (type-1A, 36%) forming a distinct solid band between the duodenum and pancreas often with histologic microabscesses (69% vs. 33% in others), and pancreas-involving (type-1B, 19%) forming a pseudotumoral mass spanning into the head-groove area, always diagnosed preoperatively as "cancer," but often lacked parenchymal atrophy of the body (44% vs. 92%). Cyst-forming (type-2) had groove-predominant (type-2A, 15%), often accompanied by Brunner gland hyperplasia, and pancreas-predominant (type-2B, 15%) were in younger (mean: 44 y) females (57% vs. 18%) and had less alcohol/tobacco abuse (50/33% vs. 81/69%). Ill-defined (type-3; 15%) often had main pancreatic duct dilatation (mean: 5.6 vs. 2.8 mm). The capricious presentations of PDP could be attributed to variable effects of different mechanistic and precipitative etiopathogenetic factors such as disturbed accessory duct outflow (dilated Santorini duct, 87%), aggravated by alcohol (77%) with superimposed stasis in the main ampulla (previous cholecystectomy, 47%; choledocholithiasis, 9%), strictured Wirsung duct (68%), and some likely exacerbated by ischemia (hypertension [59%], tobacco abuse [64%], arteriosclerosis in the tissue [23%]). In conclusion, our study identified 3 distinct types of PDP and each may reflect different pathogenetic contributing factors.

Original languageEnglish (US)
Pages (from-to)1347-1363
Number of pages17
JournalAmerican Journal of Surgical Pathology
Volume41
Issue number10
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Pancreatic Ducts
Pancreatitis
Pancreas
Tobacco
Brunner Glands
Choledocholithiasis
Arteriosclerosis
Cholecystectomy
Duodenum
Alcoholism
Atrophy
Hyperplasia
Cysts
Dilatation
Neoplasms
Ischemia
Head
Alcohols
Hypertension

Keywords

  • GEL
  • IgG4
  • LPSP
  • autoimmune pancreatitis
  • classification
  • groove
  • pancreatic cancer
  • pancreatitis
  • paraduodenal
  • pathogenesis

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Paraduodenal Pancreatitis : Imaging and Pathologic Correlation of 47 Cases Elucidates Distinct Subtypes and the Factors Involved in its Etiopathogenesis. / Muraki, Takashi; Kim, Grace E.; Reid, Michelle D.; Mittal, Pardeep Kumar; Bedolla, Gabriela; Memis, Bahar; Pehlivanoglu, Burcin; Freedman, Alexa; Erbarut Seven, Ipek; Choi, Hyejeong; Kooby, David; Maithel, Shishir K.; Sarmiento, Juan M.; Krasinskas, Alyssa; Adsay, Volkan.

In: American Journal of Surgical Pathology, Vol. 41, No. 10, 01.01.2017, p. 1347-1363.

Research output: Contribution to journalArticle

Muraki, T, Kim, GE, Reid, MD, Mittal, PK, Bedolla, G, Memis, B, Pehlivanoglu, B, Freedman, A, Erbarut Seven, I, Choi, H, Kooby, D, Maithel, SK, Sarmiento, JM, Krasinskas, A & Adsay, V 2017, 'Paraduodenal Pancreatitis: Imaging and Pathologic Correlation of 47 Cases Elucidates Distinct Subtypes and the Factors Involved in its Etiopathogenesis', American Journal of Surgical Pathology, vol. 41, no. 10, pp. 1347-1363. https://doi.org/10.1097/PAS.0000000000000919
Muraki, Takashi ; Kim, Grace E. ; Reid, Michelle D. ; Mittal, Pardeep Kumar ; Bedolla, Gabriela ; Memis, Bahar ; Pehlivanoglu, Burcin ; Freedman, Alexa ; Erbarut Seven, Ipek ; Choi, Hyejeong ; Kooby, David ; Maithel, Shishir K. ; Sarmiento, Juan M. ; Krasinskas, Alyssa ; Adsay, Volkan. / Paraduodenal Pancreatitis : Imaging and Pathologic Correlation of 47 Cases Elucidates Distinct Subtypes and the Factors Involved in its Etiopathogenesis. In: American Journal of Surgical Pathology. 2017 ; Vol. 41, No. 10. pp. 1347-1363.
@article{f9729e668c83428cb62ca19b936deb14,
title = "Paraduodenal Pancreatitis: Imaging and Pathologic Correlation of 47 Cases Elucidates Distinct Subtypes and the Factors Involved in its Etiopathogenesis",
abstract = "Clinicopathologic characteristics of paraduodenal (groove) pancreatitis (PDP) remain to be fully unraveled. In this study, 47 PDPs with preoperative enhanced images available were subjected to detailed comparative analysis in conjunction with pathologic findings. PDP were predominantly in males (3:1) with a mean age of 50 years, and 60{\%} had a preoperative diagnosis of cancer. Mean lesional size was 3.1 cm. Three distinct subtypes were identified by imaging. Solid-tumoral (type-1) with groove-predominant (type-1A, 36{\%}) forming a distinct solid band between the duodenum and pancreas often with histologic microabscesses (69{\%} vs. 33{\%} in others), and pancreas-involving (type-1B, 19{\%}) forming a pseudotumoral mass spanning into the head-groove area, always diagnosed preoperatively as {"}cancer,{"} but often lacked parenchymal atrophy of the body (44{\%} vs. 92{\%}). Cyst-forming (type-2) had groove-predominant (type-2A, 15{\%}), often accompanied by Brunner gland hyperplasia, and pancreas-predominant (type-2B, 15{\%}) were in younger (mean: 44 y) females (57{\%} vs. 18{\%}) and had less alcohol/tobacco abuse (50/33{\%} vs. 81/69{\%}). Ill-defined (type-3; 15{\%}) often had main pancreatic duct dilatation (mean: 5.6 vs. 2.8 mm). The capricious presentations of PDP could be attributed to variable effects of different mechanistic and precipitative etiopathogenetic factors such as disturbed accessory duct outflow (dilated Santorini duct, 87{\%}), aggravated by alcohol (77{\%}) with superimposed stasis in the main ampulla (previous cholecystectomy, 47{\%}; choledocholithiasis, 9{\%}), strictured Wirsung duct (68{\%}), and some likely exacerbated by ischemia (hypertension [59{\%}], tobacco abuse [64{\%}], arteriosclerosis in the tissue [23{\%}]). In conclusion, our study identified 3 distinct types of PDP and each may reflect different pathogenetic contributing factors.",
keywords = "GEL, IgG4, LPSP, autoimmune pancreatitis, classification, groove, pancreatic cancer, pancreatitis, paraduodenal, pathogenesis",
author = "Takashi Muraki and Kim, {Grace E.} and Reid, {Michelle D.} and Mittal, {Pardeep Kumar} and Gabriela Bedolla and Bahar Memis and Burcin Pehlivanoglu and Alexa Freedman and {Erbarut Seven}, Ipek and Hyejeong Choi and David Kooby and Maithel, {Shishir K.} and Sarmiento, {Juan M.} and Alyssa Krasinskas and Volkan Adsay",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/PAS.0000000000000919",
language = "English (US)",
volume = "41",
pages = "1347--1363",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Paraduodenal Pancreatitis

T2 - Imaging and Pathologic Correlation of 47 Cases Elucidates Distinct Subtypes and the Factors Involved in its Etiopathogenesis

AU - Muraki, Takashi

AU - Kim, Grace E.

AU - Reid, Michelle D.

AU - Mittal, Pardeep Kumar

AU - Bedolla, Gabriela

AU - Memis, Bahar

AU - Pehlivanoglu, Burcin

AU - Freedman, Alexa

AU - Erbarut Seven, Ipek

AU - Choi, Hyejeong

AU - Kooby, David

AU - Maithel, Shishir K.

AU - Sarmiento, Juan M.

AU - Krasinskas, Alyssa

AU - Adsay, Volkan

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Clinicopathologic characteristics of paraduodenal (groove) pancreatitis (PDP) remain to be fully unraveled. In this study, 47 PDPs with preoperative enhanced images available were subjected to detailed comparative analysis in conjunction with pathologic findings. PDP were predominantly in males (3:1) with a mean age of 50 years, and 60% had a preoperative diagnosis of cancer. Mean lesional size was 3.1 cm. Three distinct subtypes were identified by imaging. Solid-tumoral (type-1) with groove-predominant (type-1A, 36%) forming a distinct solid band between the duodenum and pancreas often with histologic microabscesses (69% vs. 33% in others), and pancreas-involving (type-1B, 19%) forming a pseudotumoral mass spanning into the head-groove area, always diagnosed preoperatively as "cancer," but often lacked parenchymal atrophy of the body (44% vs. 92%). Cyst-forming (type-2) had groove-predominant (type-2A, 15%), often accompanied by Brunner gland hyperplasia, and pancreas-predominant (type-2B, 15%) were in younger (mean: 44 y) females (57% vs. 18%) and had less alcohol/tobacco abuse (50/33% vs. 81/69%). Ill-defined (type-3; 15%) often had main pancreatic duct dilatation (mean: 5.6 vs. 2.8 mm). The capricious presentations of PDP could be attributed to variable effects of different mechanistic and precipitative etiopathogenetic factors such as disturbed accessory duct outflow (dilated Santorini duct, 87%), aggravated by alcohol (77%) with superimposed stasis in the main ampulla (previous cholecystectomy, 47%; choledocholithiasis, 9%), strictured Wirsung duct (68%), and some likely exacerbated by ischemia (hypertension [59%], tobacco abuse [64%], arteriosclerosis in the tissue [23%]). In conclusion, our study identified 3 distinct types of PDP and each may reflect different pathogenetic contributing factors.

AB - Clinicopathologic characteristics of paraduodenal (groove) pancreatitis (PDP) remain to be fully unraveled. In this study, 47 PDPs with preoperative enhanced images available were subjected to detailed comparative analysis in conjunction with pathologic findings. PDP were predominantly in males (3:1) with a mean age of 50 years, and 60% had a preoperative diagnosis of cancer. Mean lesional size was 3.1 cm. Three distinct subtypes were identified by imaging. Solid-tumoral (type-1) with groove-predominant (type-1A, 36%) forming a distinct solid band between the duodenum and pancreas often with histologic microabscesses (69% vs. 33% in others), and pancreas-involving (type-1B, 19%) forming a pseudotumoral mass spanning into the head-groove area, always diagnosed preoperatively as "cancer," but often lacked parenchymal atrophy of the body (44% vs. 92%). Cyst-forming (type-2) had groove-predominant (type-2A, 15%), often accompanied by Brunner gland hyperplasia, and pancreas-predominant (type-2B, 15%) were in younger (mean: 44 y) females (57% vs. 18%) and had less alcohol/tobacco abuse (50/33% vs. 81/69%). Ill-defined (type-3; 15%) often had main pancreatic duct dilatation (mean: 5.6 vs. 2.8 mm). The capricious presentations of PDP could be attributed to variable effects of different mechanistic and precipitative etiopathogenetic factors such as disturbed accessory duct outflow (dilated Santorini duct, 87%), aggravated by alcohol (77%) with superimposed stasis in the main ampulla (previous cholecystectomy, 47%; choledocholithiasis, 9%), strictured Wirsung duct (68%), and some likely exacerbated by ischemia (hypertension [59%], tobacco abuse [64%], arteriosclerosis in the tissue [23%]). In conclusion, our study identified 3 distinct types of PDP and each may reflect different pathogenetic contributing factors.

KW - GEL

KW - IgG4

KW - LPSP

KW - autoimmune pancreatitis

KW - classification

KW - groove

KW - pancreatic cancer

KW - pancreatitis

KW - paraduodenal

KW - pathogenesis

UR - http://www.scopus.com/inward/record.url?scp=85030612206&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030612206&partnerID=8YFLogxK

U2 - 10.1097/PAS.0000000000000919

DO - 10.1097/PAS.0000000000000919

M3 - Article

C2 - 28795998

AN - SCOPUS:85030612206

VL - 41

SP - 1347

EP - 1363

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 10

ER -