- Email: [email protected]
Groove pancreatitis or Paraduodenal pancreatitis: what’s in a name?
Clinical Imaging xxx (2015) xxx
Contents lists available at ScienceDirect
Clinical Imaging journal homepage: http://www.clinicalimaging.org
Letter to the Editor Groove pancreatitis or Paraduodenal pancreatitis: what’s in ★ a name?☆,☆☆,
Acknowledgments None.
Sir, We would like to thank Hungerford et al. [1] for beautifully appraising groove pancreatitis in their well-illustrated pictorial review in the February issue of Clinical Imaging. However, we would like to acquaint the readership with other terminologies that are used synonymously to describe groove pancreatitis including paraduodenal pancreatitis, cystic duodenal dystrophy, duodenal pancreatitis, etc. [2,3]. Of these, paraduodenal pancreatitis needs a distinct mention. In 2004, paraduodenal pancreatitis (PP) was proposed as an umbrella term to encompass groove pancreatitis, cystic dystrophy of heterotopic pancreas (or duodenal dystrophy/paraduodenal wall cyst), and pancreatic duodenal hamartomas [4]. This was following an observation by Adsay and Zamboni that all these entities shared common clinicopathological features of a fibroinflammatory process centered at the descending duodenum (primarily in the minor papilla region) in young chronic alcoholic men, often associated with varying degrees of involvement of the pancreaticoduodenal groove and/or the adjoining pancreas [4,5]. Since then, the term paraduodenal pancreatitis has been popular in the medical literature [5–10]. Of course, what matters is that the entity should be correctly diagnosed and differentiated from pancreatic adenocarcinoma and not what it is called. Nevertheless, it is vital to stay abreast with the newer terminologies. This becomes especially relevant while collating up-to-date medical information on search tools such as PubMed [5–10]. We concur with the authors that the most important question that needs to be answered while reporting exams of such patients is to be able to rightly judge if we are dealing with a fibroinflammatory mass of groove/paraduodenal pancreatitis or with an exophytic (groove) pancreatic carcinoma. Additional to the information collated by Hungerford et al., we would like to highlight the results of seminal work done by Kalb et al. [6] in this area. Kalb and colleagues studied the diagnostic performance of contrast-material-enhanced magnetic resonance imaging for distinguishing PP from pancreatic carcinoma in 47 patients who had undergone Whipple surgery. They used the following three diagnostic criteria for differentiating PP from carcinoma, namely, focal thickening of the descending duodenum, mucosal hyperenhancement of the descending duodenum, and cystic change in the region of the accessory duct of Santorini. The authors reported that simultaneous presence of these three findings allowed differentiation of PP from pancreatic carcinoma with a diagnostic accuracy of 87.2% (41 of 47 patients) and excluded cancer with a negative predictive value of 92.9% (26 of 28 cases) [6]. The readers should therefore vigilantly look for these imaging manifestations while raising the possibility of groove/ paraduodenal pancreatitis. ☆ Study performed at: Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi, India. Tel.: +91-11-46300000; Fax: +91-11-46300010. ☆☆ Conflict of interest: none. ★ Financial disclosure: none.
Ankur Arora Institute of Liver & Biliary Sciences, D-1 Vasant Kunj New Delhi, 110070, India Corresponding author. Institute of Liver & Biliary Sciences D-1 Vasant Kunj, New Delhi-110070, India Tel.: +91 9873030114; fax: +91 11 46300010 E-mail address: [email protected] Kalpana Bansal1 Department of Radiology, Institute of Liver and Biliary Sciences D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India E-mail address: [email protected] Binit Sureka 2 Department of Pathology, Institute of Liver and Biliary Sciences D-1, Vasant Kunj, New Delhi, 110070, India E-mail address: [email protected] 1
Tel.: +91 9540946858; fax: +91 11 46300010
2
Tel.: +91 9013082292; fax: +91 11 46300010
Available online xxxx http://dx.doi.org/10.1016/j.clinimag.2015.03.008 References [1] Hungerford JP, Neill Magarik MA, Hardie AD. The breadth of imaging findings of groove pancreatitis. Clin Imaging 2015. http://dx.doi.org/10.1016/j.clinimag.2015. 01.018 [pii: S0899-7071(15)00043-1.; Epub ahead of print; Review. PubMed PMID: 25770902]. [2] Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK. Dual-phase CT findings of groove pancreatitis. Eur J Radiol 2014;83:1337–43. [3] Egorov VI, Vankovich AN, Kurushkina NA, Yashina NI, Dubova EA, Petrov RV. Duodenal dystrophy—is it “paraduodenal” or “duodenal” pancreatitis. Experience of 52 patients’ treatment. Pancreatology 2012;12(6):539–40. [4] Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol 2004;21:247–54. [5] Arora A, Dev A, Mukund A, Patidar Y, Bhatia V, Sarin SK. Paraduodenal pancreatitis. Clin Radiol 2014;69:299–306. [6] Kalb B, Martin DR, Sarmiento JM, Erickson SH, Gober D, Tapper EB, et al. Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma. Radiology 2013;269:475–81. [7] Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, et al. "Paraduodenal" pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2009;33:2664–9. [8] Nankoe SR, Wilcox R, Roggin KK. Paraduodenal pancreatitis (groove pancreatitis) mimicking pancreatic adenocarcinoma. Clin Gastroenterol Hepatol 2012;10:A31–2. [9] Egorov VI, Vankovich AN, Petrov RV, Starostina NS, Butkevich ATs, Sazhin AV, et al. Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy. Biomed Res Int 2014;2014:185265. [10] Arvanitakis M, Rigaux J, Toussaint E, Eisendrath P, Bali MA, Matos C, et al. Endotherapy for paraduodenal pancreatitis: a large retrospective case series. Endoscopy 2014;46:580–7.
0899-7071/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Arora A, et al, Groove pancreatitis or Paraduodenal pancreatitis: what’s in a name?, Clin Imaging (2015), http:// dx.doi.org/10.1016/j.clinimag.2015.03.008
Contents lists available at ScienceDirect
Clinical Imaging journal homepage: http://www.clinicalimaging.org
Letter to the Editor Groove pancreatitis or Paraduodenal pancreatitis: what’s in ★ a name?☆,☆☆,
Acknowledgments None.
Sir, We would like to thank Hungerford et al. [1] for beautifully appraising groove pancreatitis in their well-illustrated pictorial review in the February issue of Clinical Imaging. However, we would like to acquaint the readership with other terminologies that are used synonymously to describe groove pancreatitis including paraduodenal pancreatitis, cystic duodenal dystrophy, duodenal pancreatitis, etc. [2,3]. Of these, paraduodenal pancreatitis needs a distinct mention. In 2004, paraduodenal pancreatitis (PP) was proposed as an umbrella term to encompass groove pancreatitis, cystic dystrophy of heterotopic pancreas (or duodenal dystrophy/paraduodenal wall cyst), and pancreatic duodenal hamartomas [4]. This was following an observation by Adsay and Zamboni that all these entities shared common clinicopathological features of a fibroinflammatory process centered at the descending duodenum (primarily in the minor papilla region) in young chronic alcoholic men, often associated with varying degrees of involvement of the pancreaticoduodenal groove and/or the adjoining pancreas [4,5]. Since then, the term paraduodenal pancreatitis has been popular in the medical literature [5–10]. Of course, what matters is that the entity should be correctly diagnosed and differentiated from pancreatic adenocarcinoma and not what it is called. Nevertheless, it is vital to stay abreast with the newer terminologies. This becomes especially relevant while collating up-to-date medical information on search tools such as PubMed [5–10]. We concur with the authors that the most important question that needs to be answered while reporting exams of such patients is to be able to rightly judge if we are dealing with a fibroinflammatory mass of groove/paraduodenal pancreatitis or with an exophytic (groove) pancreatic carcinoma. Additional to the information collated by Hungerford et al., we would like to highlight the results of seminal work done by Kalb et al. [6] in this area. Kalb and colleagues studied the diagnostic performance of contrast-material-enhanced magnetic resonance imaging for distinguishing PP from pancreatic carcinoma in 47 patients who had undergone Whipple surgery. They used the following three diagnostic criteria for differentiating PP from carcinoma, namely, focal thickening of the descending duodenum, mucosal hyperenhancement of the descending duodenum, and cystic change in the region of the accessory duct of Santorini. The authors reported that simultaneous presence of these three findings allowed differentiation of PP from pancreatic carcinoma with a diagnostic accuracy of 87.2% (41 of 47 patients) and excluded cancer with a negative predictive value of 92.9% (26 of 28 cases) [6]. The readers should therefore vigilantly look for these imaging manifestations while raising the possibility of groove/ paraduodenal pancreatitis. ☆ Study performed at: Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi, India. Tel.: +91-11-46300000; Fax: +91-11-46300010. ☆☆ Conflict of interest: none. ★ Financial disclosure: none.
Ankur Arora Institute of Liver & Biliary Sciences, D-1 Vasant Kunj New Delhi, 110070, India Corresponding author. Institute of Liver & Biliary Sciences D-1 Vasant Kunj, New Delhi-110070, India Tel.: +91 9873030114; fax: +91 11 46300010 E-mail address: [email protected] Kalpana Bansal1 Department of Radiology, Institute of Liver and Biliary Sciences D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India E-mail address: [email protected] Binit Sureka 2 Department of Pathology, Institute of Liver and Biliary Sciences D-1, Vasant Kunj, New Delhi, 110070, India E-mail address: [email protected] 1
Tel.: +91 9540946858; fax: +91 11 46300010
2
Tel.: +91 9013082292; fax: +91 11 46300010
Available online xxxx http://dx.doi.org/10.1016/j.clinimag.2015.03.008 References [1] Hungerford JP, Neill Magarik MA, Hardie AD. The breadth of imaging findings of groove pancreatitis. Clin Imaging 2015. http://dx.doi.org/10.1016/j.clinimag.2015. 01.018 [pii: S0899-7071(15)00043-1.; Epub ahead of print; Review. PubMed PMID: 25770902]. [2] Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK. Dual-phase CT findings of groove pancreatitis. Eur J Radiol 2014;83:1337–43. [3] Egorov VI, Vankovich AN, Kurushkina NA, Yashina NI, Dubova EA, Petrov RV. Duodenal dystrophy—is it “paraduodenal” or “duodenal” pancreatitis. Experience of 52 patients’ treatment. Pancreatology 2012;12(6):539–40. [4] Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol 2004;21:247–54. [5] Arora A, Dev A, Mukund A, Patidar Y, Bhatia V, Sarin SK. Paraduodenal pancreatitis. Clin Radiol 2014;69:299–306. [6] Kalb B, Martin DR, Sarmiento JM, Erickson SH, Gober D, Tapper EB, et al. Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma. Radiology 2013;269:475–81. [7] Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, et al. "Paraduodenal" pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2009;33:2664–9. [8] Nankoe SR, Wilcox R, Roggin KK. Paraduodenal pancreatitis (groove pancreatitis) mimicking pancreatic adenocarcinoma. Clin Gastroenterol Hepatol 2012;10:A31–2. [9] Egorov VI, Vankovich AN, Petrov RV, Starostina NS, Butkevich ATs, Sazhin AV, et al. Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy. Biomed Res Int 2014;2014:185265. [10] Arvanitakis M, Rigaux J, Toussaint E, Eisendrath P, Bali MA, Matos C, et al. Endotherapy for paraduodenal pancreatitis: a large retrospective case series. Endoscopy 2014;46:580–7.
0899-7071/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Arora A, et al, Groove pancreatitis or Paraduodenal pancreatitis: what’s in a name?, Clin Imaging (2015), http:// dx.doi.org/10.1016/j.clinimag.2015.03.008