Idiopathic chronic pancreatitis in children: MR cholangiopancreatography after secretin administration

PURPOSE: To assess the accuracy of dynamic magnetic resonance (MR) cholangiopancreatography after secretin administration in detecting pancreatic duct abnormalities typical of early-onset idiopathic chronic pancreatitis in children with recurrent episodes of idiopathic acute pancreatitis. MATERIALS AND METHODS: Fifteen children (mean age, 11.3 years; range, 6-17 years) with at least three recurrent episodes of idiopathic acute pancreatitis prospectively underwent MR cholangiopancreatography before and after secretin administration. Image analysis included visualization of side branches, ductal narrowing, endoluminal filling defects, irregular ductal contour, cavities, and pancreas divisum. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Dilated side branches were detected in three (20%) of 15 patients on MR cholangiopancreatograms obtained before secretin administration and in seven (47%) of 15 patients on images obtained after secretin administration. Ductal narrowing was detected in one (7%) of 15 patients on images obtained before secretin administration and in two (13%) of 15 patients on images obtained after secretin administration. Endoluminal filling defects in one (7%) of 15 patients were observed on MR cholangiopancreatograms obtained both before and after secretin administration. Irregular contour of the main pancreatic duct was present in four (27%) of 15 patients on MR cholangiopancreatograms obtained before secretin administration and in five (33%) of 15 patients on images obtained after secretin administration. Cavities and pancreas divisum were detected in one (7%) of 15 patients and in two (13%) of 15 patients, respectively, only on MR cholangiopancreatograms obtained after secretin administration. CONCLUSION: Secretin improves the sensitivity of MR cholangiopancreatography in diagnosing early-onset idiopathic chronic pancreatitis.     

Pancreas divisum and santorinicele: assessment by dynamic magnetic resonance cholangiopancreatography during secretin stimulation

PURPOSE: To evaluate the usefulness of MRCP, before and after secretin administration, in diagnosing Santoriniceles in patients with pancreas divisum. MATERIAL AND METHODS: One hundred and eight patients with suspected pancreatic disease, underwent dynamic magnetic resonance cholangiopancreatography (MRCP) before and after secretin administration (S-MRCP). S-MRCP images were evaluated for presence/absence of pancreas divisum, Santorinicele; size of the main pancreatic duct and of the Santorinicele. The onset of duodenal filling was calculated on dynamic S-MRCP images. S-MRCP findings were compared to endoscopic retrograde cholangiopancreatography (ERCP) ones (39/108). RESULTS: Pancreas divisum (PD) was detected in 6/108 patients (6%) at MRCP, and in 16/108 patients (14%) at S-MRCP. ERCP confirmed the diagnosis in 12/16 patients, with 1 false positive. 3 patients did not undergo ERCP. Santorinicele was detected in 4/108 (3%) patients at MRCP and in additional 4/108 (3%) patients at S-RMCP, only in patients with PD. Santoriniceles were confirmed in 7/8 patients at ERCP; in 1/8 patient CPRE was unsuccessful. The duct of Santorini was significantly larger (p< 0.05), in the pancreatic head, in patients with PD and Santorinicele (3.6 mm) compared to those with PD only (2.2 mm). A significant reduction in size of the pancreatic duct (26%) and of the Santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was significantly delayed in patients with Santorinicele (2.1 vs 1.3 minutes)(p<0.05). CONCLUSIONS: S-MRCP helps to identify patients with pancreas divisum and Santorinicele, a known cause of impeded pancreatic outflow which benefits from endoscopic treatment.     

Pancreas divisum: thin-section CT

Twelve patients with known pancreas divisum underwent thin-section computed tomography (CT) to determine the capability of CT to depict this pancreatic anomaly. Focal pancreatic enlargement was present in five patients. Two distinct pancreatic moieties separated by a fat cleft were noted in three patients; a fourth patient had focal atrophy in the distribution of the dorsal pancreas. The two pancreatic moieties were identified at the same craniocaudal level in all four of these patients. The dorsal duct was depicted in all 12 patients, while the short ventral duct was seen in only five of the 12 patients. Failure of the ventral and dorsal pancreatic ducts to fuse was identified in all five patients in whom both ducts were seen. CT may not enable specific diagnosis of pancreas divisum in the majority of patients. If, however, distinct pancreatic moieties or unfused ductal systems are evident, the diagnosis may be confidently suggested.     

Enlargement of the pancreatic head in patients with pancreas divisum

Pancreas divisum (PD) is a congenital anomaly present in 6-10% of the population. Computed tomography (CT) examinations in eight of 15 patients (53%) with endoscopic retrograde pancreatography (ERCP)-proven PD were interpreted as showing enlargement of the pancreatic head. Two of these had carcinoma, three had pancreatitis limited to the ventral pancreas, and three were normal. Criteria to distinguish nonpathologic enlargement of the pancreatic head due to PD alone from pathologic causes may include homogeneous parenchyma and an absence of other abnormal signs on CT. Because PD may simulate a pancreatic head mass, the radiologist should be familiar with this variant, and ERCP should precede biopsy unless other evidence of malignancy is present.     

CT appearance of the ventral pancreas

Pancreas divisum has not been previously described in the computed tomography (CT) literature of the pancreas. Nine endoscopic retrograde choledochopancreatography (ERCP) confirmed examples of pancrease divisum were evaluated by CT. Four patients (44.4%) were observed to have a characteristic lobulated appearance of the pancreatic head. Of 21 patients with a normal pancreas confirmed by ERCP, only 2 (9.5%) showed lobulation on CT. The incidence of this previously unreported configuration was found to be significantly higher (p less than 0.05) in patients with pancreas divisum than in those with normal ductal anatomy.     

Bilobular pancreas: another variant of the divided pancreas?

BACKGROUND: Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. CASE REPORT: We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. CONCLUSION: The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.     

自身免疫性胰腺炎多种影像学比较分析

目的 探讨多种影像学检查对自身免疫性胰腺炎(AIP)的诊断价值.方法 回顾性分析我院2008年4月至2011年12月17例AIP患者的临床及影像学资料,男性13例,女性4例,年龄48～68岁,17例均行CT平扫及增强扫描;12例行磁共振成像(MRI)及磁共振胰胆管造影(MRCP)检查,9例行经内镜逆行胰胆管造影(ERCP)检查且7例同时行胆总管支架置入术.结果 CT、MRI既可以显示胰腺形态改变;也可以发现胰腺周围结构改变,而MRCP和ERCP可显示胰胆管结构改变.结论 自身免疫性胰腺炎影像学表现具有一定的特征性,结合多种影像学检查早期诊断和治疗对预后有重要意义.     

Diagnostic value of multislice computed tomography for pancreas divisum: assessment with oblique coronal reconstruction images

OBJECTIVES: To assess the capabilities of high-resolution oblique coronal reconstruction images obtained by multislice computed tomography (CT) in diagnosing pancreas divisum. METHODS: This study included 11 patients with and 53 without pancreas divisum confirmed by direct cholangiopancreatography. Two blinded readers retrospectively interpreted oblique coronal reconstruction images with 0.5-mm continuous slices generated from isotropic or nearly isotropic pancreatic phase images with the scrolling mode and assessed the continuity of the ventral pancreatic duct, dorsal pancreatic duct, and main pancreatic duct in the body. The results were correlated with the findings of direct cholangiopancreatography. Other abnormal findings of the pancreatobiliary region on CT were also recorded in patients with pancreas divisum. RESULTS: The sensitivity and specificity of CT for diagnosing pancreas divisum were 100% and 89%, respectively. Computed tomography demonstrated all associated pancreatobiliary diseases. CONCLUSION: High-resolution oblique coronal reconstruction images allow us to make a diagnosis of pancreas divisum by depicting the continuity of the pancreatic ducts.     

Choledochocele with pancreas divisum:A rare cooccurrence diagnosed on magnetic resonance cholangiopancreatography

We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopancreatography (MRCP). Small choledochocele is rare congenital malformation associated with non-specific symptoms and a delay in diagnosis. The coexistence of choledochocele and pancreas divisum is extremely rare with only two case reports published in literature. In both cases MRCP failed to diagnose any biliary or pancreatic abnormality. This case suggests that the patients with recurrent abdominal pain and pancreas divisum should not be presumed to be suffering from pancreatitis. Careful evaluated for additional anomalies in the biliary tree should be sought for refractory symptoms. MRCP is a useful one-stop-shop for diagnosing pancreatic and biliary ductal anomalies.     

Pankreas — Teil I

The pancreas develops from ventral and the dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum because of insufficient drainage. MR cholangiopancreatography (MRCP) is the technique of choice for detecting pancreas divisum non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (and sometimes stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. The Atlanta classification differentiates between mild acute and severe acute pancreatitis associated with organ failure and/or local complications such as necrosis, abscess or pseudocyst. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of disease. Balthazar et al.’s CT severity index assesses the risk of mortality and morbidity. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.     

Detectability of pancreas divisum in patients with acute pancreatitis on multi-detector row computed tomography

The purpose of this study was to retrospectively assess the diagnostic performance of multi-detector row computed tomography (MDCT) in an evaluation of pancreas divisum using endoscopic retrograde pancreatography (ERP) as the reference standard. We analyzed 41 consecutive patients (14 cases of pancreas divisum and 27 cases of standard anatomy) who had undergone both MDCT and ERP for the evaluation of clinically diagnosed acute pancreatitis between November 2004 and June 2007. The CT reconstruction thickness and interval were both 3 mm. Two radiologists independently reviewed CT data, and the diagnostic confidence in determining the pancreatic ductal anatomy was scored using a five-point scale. CT detectability was correlated with the severity of pancreatitis and the degree of pancreatic necrosis based on the Balthazar index. With consensus, 16 of 41 cases (39.0%) were evaluated as indeterminate. Ductal anatomy was correctly diagnosed in 23 of 41 cases (56.1%). Eight of 14 cases (57.1%) were correctly diagnosed as pancreas divisum. Standard anatomy was identified in 15 of 27 cases (55.6%). The inter-observer agreement was substantial (κ = 0.71). Grade B or more pancreatitis and the presence of pancreatic necrosis significantly influenced the evaluation of ductal anatomy (p = 0.01 and p < 0.01, respectively). Pancreas divisum was correctly diagnosed in the case of grade A acute pancreatitis. The CT detectability of pancreas divisum in patients with grade B or more pancreatitis is still relatively low even in the MDCT era.     

Pancreas. Part I: congenital changes, acute and chronic pancreatitis

The pancreas develops from ventral and the dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum because of insufficient drainage. MR cholangiopancreatography (MRCP) is the technique of choice for detecting pancreas divisum non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (and sometimes stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. The Atlanta classification differentiates between mild acute and severe acute pancreatitis associated with organ failure and/or local complications such as necrosis, abscess or pseudocyst. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of disease. Balthazar et al.'s CT severity index assesses the risk of mortality and morbidity. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.     

Pancreas. Congenital changes, acute and chronic pancreatitis

The pancreas develops from ventral and dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum. MR cholangiopancreatography (MRCP) is the technique of choice for detecting it non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of this disease. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.     

Pancreas divisum: depiction with multi-detector row CT

PURPOSE: To retrospectively evaluate contrast material-enhanced multi-detector row computed tomography (CT) in the depiction of pancreas divisum. MATERIALS AND METHODS: This study was approved by the investigational review board. Seventy-seven patients (46 men and 31 women; mean age, 51 years) underwent CT with a four-detector row scanner and endoscopic retrograde pancreatography (ERP). Section thickness was 3.2 mm, and the reconstruction interval was 3 mm. Two radiologists independently evaluated the CT data sets with picture archiving and communication system (PACS) workstations equipped with software for two- and three-dimensional postprocessing reformations; the radiologists were blinded to the clinical and ERP data. Pancreas divisum was diagnosed at CT if what the authors termed the "dominant dorsal duct sign" (the caliber of the dorsal duct was larger than that of the ventral duct) was present and if the dorsal and ventral ducts did not appear to communicate with each other at cine review of images. ERP findings were used as the standard of reference for determining the performance (sensitivity, specificity, positive and negative predictive values) of the radiologists' CT interpretations. Interobserver agreement was measured by using kappa statistics. RESULTS: For four of the 77 patients (5%), both radiologists considered that depiction of the pancreatic duct on CT images was not sufficient to enable evaluation of ductal anatomy. These patients were excluded from further analysis. In the remaining 73 patients, ERP demonstrated pancreas divisum in 10 (14%); both observers made the correct diagnosis in nine of these patients. In addition, one radiologist had one false-positive interpretation, whereas the other radiologist had two false-positive interpretations. Thus, for observer 1, the calculated sensitivity was 90% (95% confidence interval [CI], 60%-98%) and the specificity was 98% (95% CI, 91%-100%). For observer 2, sensitivity was 90% (95% CI, 60%-98%) and specificity was 97% (95% CI, 89%-99%). Interobserver agreement was excellent (kappa = 0.93). CONCLUSION: CT scans obtained with multi-detector row scanners and interpreted with PACS workstations enable depiction of pancreas divisum. This assessment is possible only when the pancreatic duct is visualized.     

Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation

PURPOSE: To assess whether secretin stimulation improves visualization of the pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP) in patients with severe chronic pancreatitis or suspected pancreatic disease. MATERIALS AND METHODS: Thirty-one patients (group 1) with chronic pancreatitis and 84 patients (group 2) with clinical and/or laboratory findings suggestive of pancreatic disease who did not have ductal alterations at ultrasonography (US) and/or computed tomography (CT) underwent MRCP before and up to 10 minutes after secretin stimulation. Size of the main pancreatic duct (head, body, tail) and duodenal filling before and after secretin stimulation were measured quantitatively. Image quality, number of main pancreatic ductal segments visualized, visualization of side branches, ductal narrowing, endoluminal filling defects, and presence of pancreas divisum were analyzed qualitatively. RESULTS: In both groups, the size of the main pancreatic duct increased significantly 3 minutes after secretin stimulation. Reduced duodenal filling was detected in patients with severe chronic pancreatitis (P < .001). The number of segments of the main pancreatic duct visualized improved from 85 (91%) to 93 (100%) of 93 in group 1 and from 164 (65%) to 245 (97%) of 252 (P < .001) in group 2. Visualization of side branches improved from 22 (71%) to 31 (100%) of 31 in group 1 and from three (4%) to 53 (63%) of 84 (P < .001) in group 2. Pancreas divisum was visualized in one additional patient in group 1 and in six additional patients in group 2. CONCLUSION: The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of exocrine reserve.     

Dynamic MR pancreatography after secretin administration: image quality and diagnostic accuracy

OBJECTIVE: The objective of our study was to assess the improvement of image quality and diagnostic accuracy of secretin-enhanced MR pancreatography compared with conventional MR pancreatography. SUBJECTS AND METHODS: Ninety-five patients were studied with a 1.5-T scanner using a T2-weighted single-slice fast spin-echo sequence. Image quality and diameter of the head, body, and tail portion of the pancreatic main duct, the accessory duct, and the side branches were assessed before and after IV administration of secretin. Diagnoses before and after secretin administration were evaluated in a blinded fashion and correlated to the final diagnoses based on endoscopic retrograde cholangiopancreatography (ERCP), intraoperative results, and clinical follow-up as the reference standard. RESULTS: In patients with a normal pancreatic duct, the visualization of all portions of the main pancreatic duct and the accessory duct was significantly improved with dynamic MR pancreatography (p < or = 0.001). In patients with chronic pancreatitis, the visualization of the main duct was also significantly improved with dynamic MR pancreatography (p < or = 0.05). However, the visualization of the minor duct and the side branches was significantly improved only in patients showing no ductal stricture (p < or = 0.05), compared with those with ductal stricture (not significant). The overall sensitivity for the detection of chronic pancreatitis increased from 77% to 89% using secretin-enhanced MR pancreatography. A pancreas divisum was found in eight patients before and 13 patients after secretin administration. The overall negative predictive value of MR pancreatography increased from 84% to 98% after secretin administration. CONCLUSION: Improvement in image quality after secretin stimulation increases the diagnostic value of MR pancreatography in patients with a normal or nondilated main pancreatic duct and may obviate invasive procedures such as ERCP.     

Pancrease divisum: CT and ERCP findings

A case of pancreas divisum diagnosed by CT is reported. ERCP via the major pipilla revealed a very short pancreatic duct, which appeared to be abruptly interrupted by a tumor. CT, however, demonstrated two definite pancreatic moieties separated by a fat cleft, indicating the presence of pancreas divisum.     

Mucinous cystic neoplasms of the pancreas: imaging features and diagnostic difficulties

AIMS: To review the imaging features of mucinous cystic neoplasms (MCNs) of the pancreas and to highlight difficulties in differentiating these lesions from pancreatic pseudocysts.MATERIALS AND METHODS: The imaging investigations, case notes and histopathology of 13 patients who underwent surgery for an MCN of the pancreas, were reviewed.RESULTS: An erroneous diagnosis of a pancreatic pseudocyst had been made in five of the 13 cases and in two patients cystenterostomy had been performed. Only one patient had a documented history of acute pancreatitis although mildly elevated serum amylase levels were identified in a further five cases. CT and US correctly diagnosed a cystic pancreatic mass in all 13 patients, however cross-sectional imaging features of neoplasia, such as septae, cyst wall calcification, focal thickening of the cyst wall and papillary projections, were absent in five (38%) cases. Coexistent imaging features of chronic pancreatitis were present in five of the 13 patients and in six resected specimens. Cyst wall calcification occurred only in malignant lesions and there was no relationship between cyst size and the degree of malignancy. While ERCP, angiography, and percutaneous needle aspiration may provide additional information, the majority of these examinations were either unhelpful or even misleading.CONCLUSION: MCNs of the pancreas are frequently diagnosed and mismanaged as pancreatic pseudocysts with an associated increase in patient morbidity and mortality. Diagnostic imaging can help to distinguish MCNs from pseudocysts when there are features of neoplasia present, however, no imaging investigation can reliably differentiate the two conditions in all cases. If clinical doubt remains, it is preferable to err on the side of safety and either employ a 'wait and watch' strategy or to resect a cystic pancreatic lesion rather than drain a potentially malignant MCN.     

Computed tomography findings in pancreas divisum

In 29 patients with abdominal pain the diagnosis of pancreas divisum (PD) was verified by endoscopic retrograde pancreatography (ERP) via both the major and the minor papilla. Computed tomography (CT) was done in all patients to evaluate contour, volume, antero-posterior diameters and attenuation values of the gland in comparison with a normal reference series. Also, the validity of the CT grading of pancreatitis was assessed in comparison with ERP grading. Patients with PD had an increased cranio-caudal diameter of the pancreatic head (p less than 0.001). Further, the main pancreatic duct was visualized more often in patients with PD (p less than 0.01), who also had an increasing frequency of pancreatic calcifications (p less than 0.05). Otherwise there were no differences compared with the normal series. The observed reduction in the volume of the gland in patients with marked pancreatitis at ERP seemingly reflected the severity of inflammation. No cleavage between the dorsal and ventral anlage was identified. CT was found to be too unspecific to be of any use in grading of pancreatitis. In conclusion, CT findings in patients with PD are sparse, unspecific and preferably a reflection of pancreatitis, if present. ERP remains the 'gold standard' for the diagnosis.     

Multidetector computed tomography features of pancreatic metastases from leiomyosarcoma: Experience at a tertiary cancer center

AIM: To describe the multidetector computed tomography features of pancreatic metastasis from leiomyosarcoma (LMS).METHODS: Between January 1995 and December 2012, 13 consecutive patients (11 women, 2 men; mean age of 57 years; range, 38-78 years) with pancreatic metastases from LMS were included in our study. Imaging features including location, number, largest dimension, tumor attenuation and enhancement characteristics, presence of necrosis, pancreatic ductal dilatation, common bile duct (CBD) dilatation, presence of pancreatitis, and atrophy were documented.RESULTS: The most common site of origin of the pancreatic metastases from LMS was uterus (38.5%), followed by retroperitoneum (30.8%) and extremity (23.1%). None of the patients in our study had pancreas as the first site of metastasis. All patients developed pancreatic metastases at a median interval of 24 mo. Pancreatic metastases from LMS were solitary in 8/13 patients and multiple in 5/13 patients, had no predilection for any part of the pancreas, were hypovascular on arterial phase in 10/13 patients and associated with pancreatic duct dilatation in 3/13 patients. None had CBD dilatation. None of the pancreatic metastases in LMS cohort caused pancreatitis, and atrophy. Median duration of follow-up was 19 mo for LMS cohort during which two patients underwent resection of metastasis (median survival 45 mo) while the remaining underwent systemic therapy (median survival 13 mo).CONCLUSION: Pancreatic metastases from LMS are often solitary and hypovascular masses and less commonly associated with pancreatic ductal dilatation, CBD dilatation, pancreatitis or pancreatic atrophy. Surgical resection of solitary LMS pancreatic metastasis can be considered due to the long survival of these patients.