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World J Gastrointest Endosc. Mar 16, 2015; 7(3): 258-264
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.258
Head mass in chronic pancreatitis: Inflammatory or malignant
Amit K Dutta, Ashok Chacko
Amit K Dutta, Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India
Ashok Chacko, Institute of Gastroenterology and Liver Disease, the Madras Medical Mission, Chennai 600037, India
Author contributions: Dutta AK was involved in the search and review of literature and preparation of manuscript; Chacko A was involved in the concept of this study, search and review of literature, preparation of manuscript and critical appraisal.
Conflict-of-interest: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ashok Chacko, Professor, Director, Institute of Gastroenterology and Liver Disease, the Madras Medical Mission, 4-A, Dr J Jayalalitha Nagar, Mogappair, Chennai 600037, India. chacko.ashok@gmail.com
Telephone: +91-44-26565961 Fax: +91-44-26565906
Received: August 27, 2014
Peer-review started: August 28, 2014
First decision: September 30, 2014
Revised: November 15, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: March 16, 2015
Abstract

Chronic pancreatitis increases the risk of developing pancreatic cancer. This often presents as a mass lesion in the head of pancreas. Mass lesion in the head of pancreas can also occur secondary to an inflammatory lesion. Recognising this is crucial to avoid unnecessary surgery. This is sometimes difficult as there is an overlap in clinical presentation and conventional computed tomography (CT) abdomen findings in inflammatory and malignant mass. Advances in imaging technologies like endoscopic ultrasound in conjunction with techniques like fine needle aspiration, contrast enhancement and elastography as well as multidetector row CT, magnetic resonance imaging and positron emission tomography scanning have been shown to help in distinguishing inflammatory and malignant mass. Research is ongoing to develop molecular techniques to help characterise focal pancreatic mass lesions. This paper reviews the current status of imaging and molecular techniques in differentiating a benign mass lesion in chronic pancreatitis and from malignancy.

Keywords: Chronic pancreatitis, Pseudotumour, Imaging, Endoscopic ultrasonography, Molecular tool

Core tip: Evaluating head mass in chronic pancreatitis is clinically challenging. Advances in pancreatic imaging including endoscopic ultrasonography and molecular tools have been reviewed.