Imaging and Pathology of Pancreatic Neoplasms
Mirko D'Onofrio • Paola Capelli
Paolo Pederzoli
Editors
Imaging and Pathology
of Pancreatic Neoplasms
A Pictorial Atlas
Forewords by Claudio Bassi
and Roberto Pozzi Mucelli
With a contribution by Alec J. Megibow
Editors
Mirko D'Onofrio
Department of Radiology
G.B. Rossi University Hospital
Verona
Italy
Paolo Pederzoli
Department of Surgery
Casa di Cura Dott. Pederzoli
Peschiera del Garda (Verona)
Italy
Paola Capelli
Department of Pathology
G.B. Rossi University Hospital
Verona
Italy
ISBN 978-88-470-5677-0
ISBN 978-88-470-5678-7
DOI 10.1007/978-88-470-5678-7
Springer Milan Heidelberg New York Dordrecht London
(eBook)
Library of Congress Control Number: 2014951220
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Professor Carlo Procacci had perceived the idea of creating an atlas on the
imaging and pathology of pancreatic neoplasms around the year 2000. Carlo
Procacci was born in Corato, Italy, in 1950 and died in Verona, Italy, in 2004.
His idea was revived in 2012 by Paola Capelli, resulting in this book.
“Thanks Professor, the teachings last forever.”
Mirko D’Onofrio
“Friend, you will forever be in our thoughts as your thoughts will always be
part of us.”
Alec J. Megibow
Foreword I
The Verona “Pancreas Centre”, first of its kind in Italy and among only very few in the world,
devotes itself in an interdisciplinary approach to the problems of this organ, focussing on the
patient, on research, and on teaching. This dedicated center is based on 40 years of tradition.
Many respected colleagues provided essential contributions in surgery, gastroenterology,
oncology, pathology, and radiology.
In this latter field, Prof. Carlo Procacci gave an essential impetus in going from mere
descriptive radiology to a clinical approach emphasizing the integration with other disciplines.
Carlo was a radiologist who worked by seeing, perceiving, and understanding: he often was
encountered in the surgical operating rooms checking “ex vivo” what he had seen “by reflex”,
as he usually said during those years. His weekly “Thursday afternoon” interdisciplinary meetings strengthened the diagnostic and strategic potential of the pancreas Team, and this format
for clinical discussions is maintained here to the present days.
I believe that Mirko D’Onofrio, at that time one of the younger and favorite of Carlo’s
apprentices, has brilliantly compiled his teachings in this volume, reflecting how Prof. Procacci
was able to share his knowledge with others.
Apart from the professional perspectives, this book, for my brotherly friendship with Carlo,
moves me deeply and makes me feel he is still alive, here next to me.
Thanks Mirko and thanks to all your collaborating colleagues.
Verona, Italy
Claudio Bassi
vii
Foreword II
Diagnostic imaging and pathology play a crucial role in the diagnosis of pancreatic diseases.
Radiology and pathology are two distinct disciplines, but with common interests. Today, the
amount of information provided by ultrasonography, computed tomography, and magnetic
resonance images together reflects the macroscopic appearance of the pathological specimen,
and in many cases, the images of these modalities contain data that correlate with the histological characteristics of the lesion. Therefore, for modern radiologists, comparing their data with
the knowledge obtained by the pathologists has become an important part of education.
In this perspective, this pictorial atlas focusses on the correlation between imaging and
pathology based on an enormously large series of cases of pancreatic neoplasms including a
large variety of uncommon types of tumors.
This book draws on the long experience gathered in Verona, starting from many years ago
at the Policlinico Borgo Roma, now Policlinico G. B. Rossi, with studies of pancreatic diseases, which has involved distinguished surgeons, pathologists, and radiologists well known in
Italy and other countries. The book project is largely based on the enthusiasm of three colleagues: Paolo Pederzoli, with whom I have had the privilege to collaborate for 10 years; Paola
Capelli, who has a deep knowledge of the pathology of the pancreas; and Mirko D’Onofrio,
who, besides being a respected radiologist at my department, has a broad knowledge of modern imaging modalities with a special emphasis on pancreatic diseases. The deep knowledge
of these individuals and the extensive daily debates between surgeon, pathologist, and radiologist have promoted the reciprocal professional growth in this field.
This pictorial atlas is organized into ten chapters, covering the entire spectrum of pancreatic
neoplasms. Besides ductal adenocarcinoma, which is the most common pancreatic neoplasm,
the reader will also find descriptions of rare and relatively rare neoplasms, such as neuroendocrine and cystic tumors. Although some of these lesions are rare and thus possibly of limited
importance, the increased use of ultrasonography, computed tomography, and magnetic resonance imaging has led to an increased incidence, as in the case of some types of cystic tumors
detected with greater frequency by magnetic resonance imaging.
This broad collection of cases allows the reader to easily find in this pictorial atlas answers
to the most difficult challenges in the diagnostic imaging of pancreatic neoplasms. Thanks to
the excellent quality of the images, one can immediately understand the pathological features
of the studied pancreatic diseases.
Verona, Italy
Roberto Pozzi Mucelli
ix
Acknowledgments
The volume editors wish to express their most sincere thanks to the following colleagues, for
their invaluable contribution and the precious exchange of constructive clinical and scientific
experiences:
Alec J. Megibow, Cristina Hajdu, Christoph Dietrich, Enrico Martone, Giancarlo
Mansueto, Giovanni Carbognin, Carlo Biasiutti, Rossella Graziani, Alessandro Guarise,
Elisabetta Buscarini, Paolo Arcidiacono, Arnaldo Fuini, Marco Ferdeghini, Franco Bonetti,
Erminia Manfrin, Alice Parisi, Massimo Pregarz, Luigi Romano, Giuseppe Zamboni
The volume editors are furthermore grateful to the following collaborators, for their effective technical support:
Alma Olivieri, Renato Padovani, Flavio Rigo, Manola Crestani, Nicola Sperandio,
Stefano Minutelli
xi
Contents
Ductal Adenocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mirko D’Onofrio, Paola Capelli, Riccardo De Robertis,
Paolo Tinazzi Martini, Emilo Barbi, Claudia Zampini,
Stefano Crosara, Giovanni Morana, and Roberto Pozzi Mucelli
1
Neuroendocrine Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Paola Capelli, Mirko D’Onofrio, Stefano Crosara,
Paolo Tinazzi Martini, Riccardo De Robertis, Matteo Fassan,
Stefano Gobbo, Aldo Scarpa, and Roberto Pozzi Mucelli
103
Intraductal Papillary Mucinous Neoplasm (IPMN) . . . . . . . . . . . . . . . . . . . . . . . . .
Giovanni Morana, Mirko D’Onofrio, Paolo Tinazzi Martini,
Riccardo De Robertis, Stefano Crosara, Claudio Luchini, Riccardo Manfredi,
Riccardo Zanato, and Paola Capelli
195
Serous Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Paola Capelli, Paolo Tinazzi Martini, Mirko D’Onofrio,
Giovanni Morana, Riccardo De Robertis, Claudio Luchini,
Stefano Canestrini, Stefano Gobbo, and Roberto Pozzi Mucelli
277
Mucinous Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mirko D’Onofrio, Paola Capelli, Riccardo De Robertis,
Claudio Luchini, Paolo Tinazzi Martini, Stefano Crosara,
Emilio Barbi, and Giovanni Morana
311
Solid Pseudopapillary Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Giulia Anna Zamboni, Maria Chiara Ambrosetti, Sara Pecori,
Riccardo Manfredi, and Paola Capelli
349
Secondary Tumors and Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Paolo Tinazzi Martini, Roberto Malagò, Paola Capelli,
Emanuele Demozzi, Valentina Ciaravino, Francesco Erdini,
Miriam Ficial, and Roberto Pozzi Mucelli
373
Rare Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Roberto Malagò, Paola Capelli, Riccardo De Robertis, Valentina Ciaravino,
Federica Pedica, and Roberto Pozzi Mucelli
393
Driving Questions and Flowcharts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Riccardo De Robertis, Paolo Tinazzi Martini,
Stefano Crosara, Stefano Canestrini, and Mirko D’Onofrio
411
Imaging Stigmata Review and Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anna Gallotti, Francesco Alessandrino, and Fabrizio Calliada
419
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
425
xiii