Pancreatic Masses

September 10, 2020
Drs Jaimie Nathan, Rae Hanke, Alex Gibbons, and Todd Ponsky discuss diagnosis and management of pancreatic masses

Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626


  • Intro (00:00)
  • Differential diagnosis of a patient with elevated lipase and elevated bilirubin? (01:17)
  • Clues to identify diagnosis and what location in the Pancreas the tumor may be? (02:37)
  • What are the most common pediatric pancreatic tumors and what are the main features I should know about them? (05:01)
  • If it's early satiety and these vague symptoms how do they end up getting diagnosed? (07:05)
  • What are some of the most common ways that patients with pancreatic masses present? (10:47)
  • The patient with the painless jaundice and acholic stools. What lab test do you want? What imaging modalities would you use for evaluation. (12:15)
  • Can and MRI or a CT differentiate between benign and malignant cyst? (14:55)
  • Are there any signs we should know about that would point you towards malignancy on the imaging? (15:17)
  • When would we consider an EUS in these patients? (15:50)
  • Original case for the 8 year old. MRI and MRCP show dilated biliary system and mildly dilated pancreatic duct to the head. Homogenous T2 signal in the pancreatic head. ERCP performed and Biliary stint placed and Scytology negative. What do you think the diagnosis is and whats the next step? (17:47)
  • Move forward with steroids and complete 4 week course. 3 month cat scan shows discrete well circumscribed hyper enhancing head mass. Hyperechoic lesion in the pancreatic head. Fine needle aspiration shows atypical cells. Do we operate? (18:17)
  • You decide to operate. Plan? Approach? What was the actual outcome of this case? (18:47)
  • How do you approach the idea of pancreatic resection or what type of operations do you consider when you find a pancreatic mass? (21:53)
  • Post operatively what type of follow up is needed for these patients? (25:29)
  • Can you tell us more about auto immune pancreatitis and diagnostic concerns? (26:41)
  • What should surgeons know about auto immune pancreatitis (28:47)

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