Review pancreas anatomy, its relationship with adjacent structures and anatomical variants. Present pathological conditions that, if misdiagnosed, could lead to unnecessary imaging work-up and procedures. Make radiologists familiar with lesions and imaging pitfalls that can mimic pancreatic primary neoplasms.

The pancreas is a retroperitoneal organ with complex anatomical relationships with peritoneal and retroperitoneal structures (Figure 1 and 2). Lesions originating from these locations might be intrinsically related to the pancreatic parenchyma, simulating pancreatic primary neoplasms. Studies show that up to 5% of the pancreatectomies performed due to a primary clinical diagnosis of pancreas cancer are later proved to be pseudotumors by microscopic evaluation [3]. Pancreas primary neoplasms...

Several lesions and pseudolesions can simulate pancreatic primary neoplasms. In this presentation they are divided in four main groups: 1- Pseudolesions related to pancreas developmental anomalies and normal variants; 2- Lesions arising from adjacent pancreas structures; 3- Inflammatory pancreatic and peripancreatic lesions; 4- Pancreatic metastasis. 1- Pseudolesions related to pancreas developmental anomalies and normal variants. Pancreatic fusion or migration anomalies (Figures 3, 4 and 5)...

Knowledge of pancreatic embryology, anatomic relations, inflammatory lesions and other entities that mimic pancreatic primary neoplasms is essential, mainly because radiologic presentation could be very similar for the majority of these pathologies. Using and interpreting correctly imaging details and minor findings may help to approach the accurate final diagnosis, which will help primary physicians to optimize appropriate management and avoid unnecessary procedures and work-up images.

Raju et al. Population study of pancreatic cancer. Curr Oncol. 2015 Dec;22(6):e478-e484. O’Neill et al. Costs and Trends in Pancreatic Cancer Treatment. Cancer. October 15; 118(20): 5132–5139. Adsay et al. Pancreatic pseudotumors: non-neoplastic solid lesions of the pancreas that clinically mimic pancreas cancer. Seminars in Diagnostic Pathology (2004) 21, 260-267 Cerri, G G; Leite, C C; Rocha, M. Tratado de Radiologia - Vol 2. Cap 30-33. Manole. 2018. Sao Paulo/SP. Gupta et al. Blunt Trauma...