Table 1

EUS Criteria For Diagnosis of Chronic Pancreatitis

Parenchymal

heterogeneous globular architecture

5-8mm focal areas of reduced echogenicity in the periphery of the gland

increased sharp echogenic foci or bands*

enlargement of the gland

accentuation of lobular architecture

appearance of small cysts or cavities

 

Pancreatic duct

irregular duct pattern

increasing duct caliber

irregularity of the lumen

visualization of dilated side branches

increased number of side branches*

increased echogenicity of the duct wall*

intraluminal echoes (calculi and protein plugs)

strictures with dilation of the main pancreatic duct

main or branch duct disruption

*Features characteristic of early pancreatitis that are usually appreciated only with EUS 

Table 2

Classification Of Pancreatic Cystic Tumors

Tumors of the exocine pancreas

Benign:

Serous cystadenoma

 

Mucinous cystadenoma

 

Intraductal papillary-mucinous adenoma

 

Mature cystic teratoma

Borderline (uncertain malignant potential)

 

Mucinous cystic tumor with moderate dysplasia

 

Intraductal papillary-mucinous tumor with moderate dysplasia

 

Solid-pseudopapillary tumor

Malignant:

Ductal adenocarcinoma

 

Mucinous noncystic carcinoma

 

Signet ring cell carcinoma

 

Adenosquamous carcinoma

 

Undifferentiated (anaplastic) carcinoma

 

Mixed ductal-endocrine carcinoma

 

Osteoclast-like giant cell tumor

 

Serous cystadenocarcinoma

 

Mucinous cystadenocarcinoma

 

noninvasive; invasive

 

Intraductal papillary-mucinous carcinoma (papillary-mucinous carcinoma)

 

noninvasive; invasive

 

Acinar cell carcinoma

 

Acinar cell cystadenocarcinoma

 

Mixed acinar-endocrine carcinoma

 

Pancreatolastoma

 

Solid-pseudopapillary carcinoma

 

Miscellaneous carcinomas

  

Tumors of the endocrine pancreas

Bengin: Well-differentiated adenoma

 

Insulinoma

 

Nonfunctioning adenoma

Borderline (uncertain malignant potential)

 

Well-differentiated nonangioinvasive tumor

 

Insulinoma

 

Gastrinoma, vipoma, glucagonoma, somatostartinoma, others

 

Nonfunctioning tumor

Low-grade malignant:

Well to moderately differentiated carcinoma

 

Insulinoma

 

Gastrinoma, vipomas, glucagonoma, somatostatinoma, others

 

Nonfunctioning carcinoma

High-grade malignant:

Poorly differentiated carcinoma (ie small cell carcinoma)

 

Functioning or nonfunctioning

Table 2

Classification of Pancreatic Cystic Tumors

Nonepithelial Tumors

Benign soft tissue tumors

Malignant soft tissue tumors

Malignant lymphomas

 

Secondary Tumors

 

Tumor-like Lesions of the Exocrine Pancreas

Chronic pancreatits

Miscellaneous inflammatory changes

Cysts

 

Pseudocyst

 

Retention cyst

 

Parasitic cyst

 

Cogenital cyst

 

Para-ampullary duodenal wall cyst

 

Enterogenous cyst

 

Lymphoepithelial cyst

 

Endometrial cyst 

Duct changes

 

Squamous metaplasia

 

Mucinous cell hypertrophy

 

Ductal papillary hyperplasia

 

Adenomatiod ductal hyperplasia

 

Duct dysplasia

Acinar changes

Heterotopic pancreas

Hetertopic (ectopic) spleen

Hamartoma and pseudotumor

Pseudolipomatous hypertrophy

Pseudolymphoma

Islet hyperplasia

Nesidioblastosis

 

Persistent neonatal hyperinsulinemic hypoglycemia

 

Persistent hyperinsulinemic hypoglycemia in adults

Dysplasia