0:01

So there are two other kinds of pancreatitis which

0:03

can mimic masses or adenocarcinoma on imaging.

0:06

One of them is groove pancreatitis.

0:08

It is a very specific entity, very unique

0:10

entity, which involves just the groove

0:13

between the pancreatic head and the duodenum.

0:14

The etiology is unknown, but it

0:16

is mostly seen in young males.

0:18

Those have history of alcoholic abuse.

0:21

So this, these kind of pancreatitis

0:23

usually develop in the region where

0:25

the duodenal wall is present, and that

0:26

can undergo some cystic degeneration.

0:29

But the problem is those cystic degeneration

0:31

may be sometimes macroscopic and sometimes

0:33

microscopic and not seen on imaging.

0:35

And they look like just a solid

0:36

area of ill-defined soft tissue

0:39

along with the pancreatic head.

0:41

And the history is recurrent pancreatitis

0:43

and all the time patients come to the ER,

0:45

the lipase are elevated and nothing else is found.

0:48

And once we do biopsy in this region,

0:50

only inflammatory tissue comes out.

0:53

Sometimes we can see cystic areas which

0:56

may or may not be present in all cases

0:58

because sometimes it just looks like solid.

1:00

Sometimes, one of the entities, there are three

1:02

different kinds of peritoneal pancreatitis or

1:04

groove pancreatitis which can look like sometimes

1:07

absolutely solid, sometimes they are expensile

1:10

and sometimes they undergo cystic changes.

1:13

The point, important point to understand

1:14

here is, remember the cancer is cancer.

1:17

It is fibrotic tissue.

1:19

Renal carcinoma has peculiar

1:20

feature of involving the vessels.

1:23

It has fibrillatory tissue.

1:24

It's going to cause invasion of

1:26

the vessels in the surrounding.

1:28

So it will, it will never displace

1:30

the GDA along with the periphery.

1:32

It will always involve the vessel.

1:34

If there is a tumor and it is displacing

1:37

the GDA along with the periphery,

1:39

that will be most likely pancreatitis.

1:43

If the CBD is displaced, not involved by

1:45

the mass, it's just displaced medially,

1:48

then it is going to be most likely pancreatitis.

1:50

And the peculiar feature about these pancreatitis,

1:52

despite they look like mass, they're not.

1:54

Patients usually don't have the history of

1:56

obstructive jaundice, so CBD will not be dilated.

2:00

So we have to be very cautious while

2:01

dealing with the pancreatic head masses just

2:03

confined to the pancreatic redundant groove.

2:05

If they do not have significant dilation

2:07

of the CBD and if they are not involving

2:10

the vessels, if they are not involving

2:12

the lower end of CBD, rather they are

2:14

displaced rather than being involved.

2:16

So possibly that represents the

2:18

case of groove pancreatitis.