Differential Diagnosis

Most reported patients underwent a Whipple procedure because preoperative differentiation between groove pancreatitis and pancreatic cancer was difficult [7]. A mass lesion should be verified by intraoperative pathological examination to rule out a malignant lesion and to avoid unnecessary radical surgery. In addition, a duodenal mucosal biopsy of a markedly thickened duodenum is required, when endoscopy reveals luminal narrowing of the duodenum. When Brunner's gland hyperplasia is confirmed histopathologically, GP is favored, in patients with no history of gastrectomy, peptic ulcer or disease of the biliary tree.

Taya et al. [8] reported a case of minute cancer of Santorini's duct, and preoperative diagnosis was GP. If a biopsy fails to demostrate the malignant lesion of minor papilla and/or Santorini's duct, a pancreatoduodenectomy may be avoided and the patient may undergo a biliary stent placement. For this kind of unrecognized cancer, further and adequate examinations are recommended.

This type of pancreatitis is still unknown to most clinicians and patholo-gists, possibly because major textbooks of medicine and surgery do not describe it. Summarizing distinct morphologic features of pancreatic cancer and GP, in 2001 Mohl et al. [9] proposed diagnostic criteria (table 1) on differential diagnosis, in order to lead to a more reliable preoperative diagnosis and to avoid unnecessary radical surgery.

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