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Pancreatic Neoplasms: A Diagnostic Dilemma

Context: Imaging of pancreas is a challenging situation.
However rapid evolution of CT has enhanced the diagnostic
accuracy many folds.
Aim: To determine the accuracy of Multi-Detector
Computed Tomography (MDCT) in characterization of
pancreatic masses and to correlate imaging findings with
histopathological diagnosis.
Material and methods: This prospective study was carried
out on patients in Nizam's Institute of Medical Sciences,
Hyderabad from December 2016 to April 2018. A total of
histopathologically proven 35 consecutive cases with
primary pancreatic masses were analyzed.
Results: There were 17 males and 18 females with age
range from 18 to 83 years. Maximum were in 4th to 6th
decade. The final histopathology examination (HPE)
diagnosis included adenocarcinoma in 24 (68%), solid
pseudopapillary epithelial neoplasm (SPEN)-3
(8.5%),Neuroendocrine tumors (NET)-3 (8.5%), serous cyst
adenoma-2 (5.7%), mucinous cyst adenoma-1 (2.8%),
Intraductal Papillary Mucinous Neoplasm (IPMN)-1 (2.8%)
and Gastrointestinal stromal tumor (GIST)-1(2.8%). There
were 5 cases where the radiological diagnosis did not
correlate with pathological diagnosis. Mimics of ductal
adenocarcinoma are NET and cystic neoplasm in our series.
The overall diagnostic accuracy of CT was 85%.
Conclusion: Pancreatic ductal adenocarcinoma is the most
common malignancy followed by NET and cystic neoplasms.
Though extremely rare, GIST can also occur. Overall, the CT
has diagnostic accuracy of 85%. Since feasibility for
resection and prognosis are different for each type of the
tumors, definite early diagnosis is essential.

Author(s): Sana Quadri, Sujata Patnaik, Megha Uppin and Phani Chakravarthy

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