Current diagnosis and management of unusual pancreatic tumors

Background: The finding of a solid or cystic mass in the pancreas is becoming more common secondary to the increasing use of cross-sectional imaging and the improved sensitivity of such studies for the detection of pancreatic abnormalities. Because of the aggressive natural history of pancreatic cancer, this has caused concern that all pancreatic abnormalities may be cancer as well as confusion over proper diagnostic and treatment algorithms. This review provides an overview of the natural history, diagnostic considerations, and treatment recommendations for the less common tumors of the pancreas which can be misinterpreted as pancreatic cancer including: solid pseudopapillary tumors (SPT), acinar cell carcinoma (ACC), lymphoplasmacytic sclerosing pancreatitis (LPSP), primary pancreatic lymphoma (PPL), and metastatic renal cell carcinoma to the pancreas. Data sources: A Medline search was conducted to identify studies investigating the clinicopathologic features, molecular genetics, pathogenesis, diagnosis, and treatment of SPT, ACC, LPSP, PPL, and pancreatic metastases. Conclusions: It is often possible to obtain an accurate pretreatment diagnosis for these unusual pancreatic tumors and to successfully differentiate them from the more common pancreatic malignancies.