Pancreatic rule 1:Pancreatic lesions

Pancreatic lesions could be classified into three major headings which are
-Acute pancreatitis.
-Chronic pancreatitis.
-And pancreatic tumors.
Then let us discussing these three heading separately.
Acute pancreatitis:
The first one is acute pancreatitis and their radiological findings are
-Swollen pancreas.
-Dirty surrounding fat plane due to congestion or fluid collection, the latter could be localized as in case of pseudo pancreatic cyst or diffuse causing peri pancreatic fluid collection.
We have three types of acute pancreatitis which are
-Edematous type which forms about 95% of the cases.
Either heals or transform to chronic stage.
-Necrotizing pancreatitis.
Non enhanced part of the pancreas due to necrosis(presence of fluid and air).
-Hemorrhagic pancreatitis which form a surgical emergency if present and for about 5% of the cases.

Chronic pancreatitis:

-Small sized pancreas.
-Dilated pancreatic duct.
-Then, the most important sign which is presence of calcification.
-If acute pancreatitis occurred on top of chronic pancreatitis, this condition is known as relapsing pancreatitis.

Neoplasm:

-We should find  a pancreatic mass causing focal bulge and change in the size or shape of a part of the gland if compared to the rest of its parenchyma.
-We should also see evidence of dirty surrounding fat plane(this sign is less seen in neoplasm if compared with acute pancreatitis).
-Pancreatic neoplasm can be divided into three categories
Solid lesions: further more divided into two subcategories
-The first one is pancreatic carcinoma which is
@A solid mass with no calcification( absence of calcification can differentiate it from islet cell tumors which are the third category which will be discussed later in this sitting).
@Obliteration of the fat plane between the pancreas and other surrounding organs such as stomach does not means tumor infiltration. Definite evidence of tumor infiltration inside any other organs need to see the pancreatic tumor inside the affected other organ.
@Presence of vascular encasement(causing thrombosis) such as splenic vein, superior mesenteric vein or IVC means simply no surgery for this case.
The second subcategory of the solid pancreatic tumor is metastases which needs more information about presence of primary lesion else where in the body, or presence of other lesions in other places such as lymph nodes or bones.

Cystic lesions:

-Less common than solid tumors.
-Can be classified into two categories
-The first one is mucinous cyst adenoma or mucinous cystadenocarcinoma.
M from mucinous and also from magnify which means mucinous is a magnified cyst or large in size with septation to differentiate it from pseudo pancreatic cyst.سست واحد كبير جواه سبتيشن
While the second subcategory is serous cystadenoma or cystadenocarsinoma.
S from serous and also from small which means that serous cystadenoma is formed from small cyst and multiple.(just to remember).عدد كبير من السستات الصغيره

 Functioning neoplasm:

Could be
-Insulinoma which is the most common one characterized clinically by insulin over production.
Insulinoma seen as a very small hyper vascular pancreatic lesion with marked intense enhancement
-Glucagonoma.
-Gastrinoma.