title: Intense PET signal in the degenerative necrosis superimposed on chronic pancreatitis.
abstract: Although fluorine-18 deoxyglucose-positron emission tomography (FDG-PET) is a sensitive diagnostic modality in detecting malignant tumors, differential diagnosis of malignant tumors from inflammatory lesion is challenging. We experienced a case of acute degenerative necrosis superimposed on chronic pancreatitis, which was difficult to distinguish from pancreatic cancer. The patient was a 66-year-old man with a complaint of upper abdominal pain. Abdominal computed tomography revealed low-density masses in the head and body of the pancreas. FDG-PET revealed intense accumulations at the head and body of the pancreas (mean standard uptake value for the head and body pancreatic tumors was 4.1 and 6.7, respectively) corresponding to the 2 tumors detected by computed tomography. Because of a possible malignant pancreatic tumor, the patient underwent pylorus-preserving pancreatoduodenectomy. Histologic examination of the resected specimen revealed a characteristic of chronic pancreatitis in a nontumorous area. Two tumors detected by FDG-PET consisted of degenerative necrosis surrounded by granulation tissue. The amount of granulation tissue was correlated to the levels of standard uptake value. No malignant tumors were observed. This case suggests a limitation of FDG-PET in distinguishing malignant neoplastic lesions in the pancreas, especially from acute degenerative changes in chronic pancreatitis. Repetitive PET examination is recommended for the accurate diagnosis.
authors: Division of Surgical Oncology, Department of Surgery, University of Nagoya Graduate School of Medicine, Nagoya, Japan.
authors: Yukihiro
authors: Y
authors: Yokoyama
authors: Masato
authors: M
authors: Nagino
authors: Takashi
authors: T
authors: Hiromatsu
authors: Norihiro
authors: N
authors: Yuasa
authors: Koji
authors: K
authors: Oda
authors: Toshiyuki
authors: T
authors: Arai
authors: Hideki
authors: H
authors: Nishio
authors: Tomoki
authors: T
authors: Ebata
authors: Yuji
authors: Y
authors: Nimura
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D009336:Necrosis; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18