Imaging of Tropical Chronic Pancreatitis—A Unique Clinico-Radiological Entity

Chinmay Bhimaji Kulkarni; Resmi Sekhar; Srikanth Moorthy; Sreekumar Karumathil Pullara; Nirmal Kumar Prabhu; Ramiah Rajesh Kannan

doi:10.1055/s-0039-1698479

Journal of Gastrointestinal and Abdominal Radiology, Table of Contents

CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2020; 03(02): 144-152
DOI: 10.1055/s-0039-1698479

Review Article

Imaging of Tropical Chronic Pancreatitis—A Unique Clinico-Radiological Entity

Authors

Chinmay Bhimaji Kulkarni

¹Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala state, India
Resmi Sekhar

¹Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala state, India
Srikanth Moorthy

¹Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala state, India
Sreekumar Karumathil Pullara

¹Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala state, India
Nirmal Kumar Prabhu

¹Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala state, India
Ramiah Rajesh Kannan

¹Department of Radiology, Amrita Institute of Medical Sciences, Amrita Lane, Ponekkara, Cochin, Kerala state, India

Abstract

Tropical chronic pancreatitis (TCP) is a unique juvenile nonalcoholic form of chronic pancreatitis prevalent in tropical developing countries. TCP is characterized by the younger age of onset, rapid progression, higher prevalence of diabetes and pancreatic calculi, and greater propensity to develop pancreatic malignancy. Identifying the distinct imaging features is critical for the diagnosis of TCP. Awareness of this condition will not only enable the radiologist to recognize it early but also help in better management. In this article, we review the etiopathogenesis, distinct imaging features, and complications of TCP.

Keywords

chronic calcific pancreatitis - tropical pancreatitis - mutation - computed tomography - magnetic resonance imaging - pancreatic malignancy

Full Text

References

References
1 Balakrishnan V, Nair P, Radhakrishnan L, Narayanan VA. Tropical pancreatitis - a distinct entity, or merely a type of chronic pancreatitis?. Indian J Gastroenterol 2006; 25 (02) 74-81
2 Balakrishnan V, Sauniere JF, Hariharan M, Sarles H. Diet, pancreatic function, and chronic pancreatitis in south India and France. Pancreas 1988; 3 (01) 30-35
3 Zuidema PJ. Cirrhosis and disseminated calcification of the pancreas in patients with malnutrition. Trop Geogr Med 1959; 11 (01) 70-74
4 GeeVarghese PJ, Pillai VK, Joseph MP, Pitchumoni CS. The diagnosis of pancreatogenous diabetes mellitus. J Assoc Physicians India 1962; 10: 173-178
5 Geevarghese PJ. Chronic Pancreatitis and Diabetes Mellitus in the Tropics. Bombay: Varghese Publishing House; 1992: 57-60
6 Davies JNP. The essential pathology of kwashiorkor. Lancet 1948; 1 (6496) 317-320
7 Mohan V, Premalatha G. Fibrocalculous pancreatic diabetes. Int J Diabetes 1995; 3: 71-82
8 Shenoy KT, Shanmugam J, Balakrishnan V. Viral & Mycoplasma pneumoniae antibodies in chronic pancreatitis of tropics. Indian J Med Res 1986; 84: 22-26
9 Shanmugam J, Balakrishnan V, George M, Shenoy KT. Study of Coxsackie B viral infections in chronic pancreatitis patients from Kerala. J Postgrad Med 1987; 33 (01) 29-31
10 Mahurkar S, Reddy DN, Rao GV, Chandak GR. Genetic mechanisms underlying the pathogenesis of tropical calcific pancreatitis. World J Gastroenterol 2009; 15 (03) 264-269
11 Bhatia E, Choudhuri G, Sikora SS. et al. Tropical calcific pancreatitis: strong association with SPINK1 trypsin inhibitor mutations. Gastroenterology 2002; 123 (04) 1020-1025
12 McMillan DE, Geevarghese PJ. Dietary cyanide and tropical malnutrition diabetes. Diabetes Care 1979; 2 (02) 202-208
13 Mathangi DC, Namasivayam A, Mohan V. Chronic cassava feeding on pancreatic function and histology in albino rats. In: Proceedings of the Second International Conference of Tropical Gastroenterology and Hepatology. Jaipur: 1996: p. 6
14 Balakrishnan V. Tropical pancreatitis – epidemiology, pathogenesis and etiology. In: Balakrishnan V. ed. Chronic Pancreatitis in India. Trivandrum: Indian Society of Pancreatology; 1987: 79-85
15 Nagalotimath SJ. Pancreatic pathology in pancreatic calcification with diabetes. In: Podolsky S, Viswanathan M. eds. Secondary diabetes: the spectrum of diabetic syndromes. New York: Raven Press; 1980: 117-45
16 Nair B. Pathology of tropical calcific pancreatitis. In: Kumar N, Acharya SK. eds. Tropical calcific pancreatitis. Kerala: Roussel Scientific Institute; 1994: 83-90
17 Nair B, Latha P. Pancreas in chronic pancreatitis in India. In: Balakrishnan V. ed. Trivandrum: Indian Society of Pancreatology; 1987: 115-20
18 Schultz AC, Moore PB, Geevarghese PJ, Pitchumoni CS. X-ray diffraction studies of pancreatic calculi associated with nutritional pancreatitis. Dig Dis Sci 1986; 31 (05) 476-480
19 Pitchumoni CS, Viswanathan KV, Gee Varghese PJ, Banks PA. Ultrastructure and elemental composition of human pancreatic calculi. Pancreas 1987; 2 (02) 152-158
20 Nagalotimath SJ. Pancreatic in Karnataka. A note on pathology. In: Balakrishnan V. ed. Chronic pancreatitis in India. Trivandrum: Indian Society of Pancreatology; 1986: 105-111
21 Govindarajan M, Mohan V, Deepa R, Ashok S, Pitchumoni CS. Histopathology and immunohistochemistry of pancreatic islets in fibrocalculous pancreatic diabetes. Diabetes Res Clin Pract 2001; 51 (01) 29-38
22 Bolondi L, Priori P, Gullo L. et al. Relationship between morphological changes detected by ultrasonography and pancreatic exocrine function in chronic pancreatitis. Pancreas 1987; 2 (02) 222-229
23 Jones SN, Lees WR, Frost RA. Diagnosis and grading of chronic pancreatitis by morphological criteria derived by ultrasound and pancreatography. Clin Radiol 1988; 39 (01) 43-48
24 Dimcevski G, Erchinger FG, Havre R, Gilja OH. Ultrasonography in diagnosing chronic pancreatitis: new aspects. World J Gastroenterol 2013; 19 (42) 7247-7257
25 Moorthy TR, Nalini N, Narendranathan M. Ultrasound imaging in tropical pancreatitis. J Clin Ultrasound 1992; 20 (06) 389-393
26 Manfredi R, Brizi MG, Masselli G, Gui B, Vecchioli A, Marano P. Imaging of chronic pancreatitis. Rays 2001; 26 (02) 143-149
27 De Backer AI, Mortelé KJ, Ros RR, Vanbeckevoort D, Vanschoubroeck I, De Keulenaer B. Chronic pancreatitis: diagnostic role of computed tomography and magnetic resonance imaging. JBR-BTR 2002; 85 (06) 304-310
28 Luetmer PH, Stephens DH, Ward EM. Chronic pancreatitis: reassessment with current CT. Radiology 1989; 171 (02) 353-357
29 Kusano S, Kaji T, Sugiura Y, Tamai S. CT demonstration of fibrous stroma in chronic pancreatitis: pathologic correlation. J Comput Assist Tomogr 1999; 23 (02) 297-300
30 Chari S, Jayanthi V, Mohan V, Malathi S, Madanagopalan N, Viswanathan M. Radiological appearance of pancreatic calculi in tropical versus alcoholic chronic pancreatitis. J Gastroenterol Hepatol 1992; 7 (01) 42-44
31 Rosendahl J, Bödeker H, Mössner J, Teich N. Hereditary chronic pancreatitis. Orphanet J Rare Dis 2007; 2: 1-10
32 Procacci C, Graziani R, Bicego E. et al. Intraductal mucin-producing tumors of the pancreas: imaging findings. Radiology 1996; 198 (01) 249-257
33 Sugiyama M, Atomi Y, Hachiya J. Intraductal papillary tumors of the pancreas: evaluation with magnetic resonance cholangiopancreatography. Am J Gastroenterol 1998; 93 (02) 156-159
34 Procacci C, Megibow AJ, Carbognin G. et al. Intraductal papillary mucinous tumor of the pancreas: a pictorial essay. Radiographics 1999; 19 (06) 1447-1463
35 Fukukura Y, Fujiyoshi F, Sasaki M, Inoue H, Yonezawa S, Nakajo M. Intraductal papillary mucinous tumors of the pancreas: thin-section helical CT findings. AJR. Am J Roentgenol 2000; 174 (02) 441-447
36 Carnaille B, Oudar C, Pattou F, Combemale F, Rocha J, Proye C. Pancreatitis and primary hyperparathyroidism: forty cases. Aust N Z J Surg 1998; 68 (02) 117-119
37 Mithöfer K, Fernández-del Castillo C, Frick TW, Lewandrowski KB, Rattner DW, Warshaw AL. Acute hypercalcemia causes acute pancreatitis and ectopic trypsinogen activation in the rat. Gastroenterology 1995; 109 (01) 239-246
38 Prinz RA, Aranha GV. The association of primary hyperparathyroidism and pancreatitis. Am Surg 1985; 51 (06) 325-329
39 Mohan V, Premalatha G, Pitchumoni CS. Tropical chronic pancreatitis: an update. J Clin Gastroenterol 2003; 36 (04) 337-346
40 Thomas PG, Augustine P, Ramesh H, Rangabashyam N. Observations and surgical management of tropical pancreatitis in Kerala and southern India. World J Surg 1990; 14 (01) 32-42
41 Mohan V, Premalatha G, Padma A, Chari ST, Pitchumoni CS. Fibrocalculous pancreatic diabetes. Long-term survival analysis. Diabetes Care 1996; 19 (11) 1274-1278
42 Elmas N. The role of diagnostic radiology in pancreatitis. Eur J Radiol 2001; 38 (02) 120-132
43 Perez-Johnston R, Sainani NI, Sahani DV. Imaging of chronic pancreatitis (including groove and autoimmune pancreatitis). Radiol Clin North Am 2012; 50 (03) 447-466
44 Petrozza JA, Dutta SK. The variable appearance of distal common bile duct stenosis in chronic pancreatitis. J Clin Gastroenterol 1985; 7 (05) 447-450
45 Perumal S, Palaniappan R, Pillai SA, Velayutham V, Sathyanesan J. Predictors of malignancy in chronic calcific pancreatitis with head mass. World J Gastrointest Surg 2013; 5 (04) 97-103
46 Flati G, Andrén-Sandberg A, La Pinta M, Porowska B, Carboni M. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas 2003; 26 (01) 8-14
47 Kulkarni CB, Moorthy S, Pullara SK, Prabhu NK, Kannan RR, Nazar PK. Endovascular management of pancreatitis related pseudoaneurysms—A single center experience. Gastrointest Interv 2014; 3 (01) 46-53
48 Andersson E, Ansari D, Andersson R. Major haemorrhagic complications of acute pancreatitis. Br J Surg 2010; 97 (09) 1379-1384
49 Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 2005; 25 (Suppl 1) S173-S189
50 Kulkarni C, Moorthy S, Sreekumar K. et al. In the workup of patients with obscure gastrointestinal bleed, does 64-slice MDCT have a role?. Indian J Radiol Imaging 2012; 22 (01) 47-53
51 Chari ST, Mohan V, Pitchumoni CS, Viswanathan M, Madanagopalan N, Lowenfels AB. Risk of pancreatic carcinoma in tropical calcifying pancreatitis: an epidemiologic study. Pancreas 1994; 9 (01) 62-66
52 Falconi M, Casetti L, Salvia R. et al. Pancreatic head mass, how can we treat it? Chronic pancreatitis: surgical treatment. JOP 2000; 1 (Suppl. 03) 154-161
53 Beger HG, Schlosser W, Friess HM, Büchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann Surg 1999; 230 (04) 512-519 discussion 519–523
54 Pulay I, Tihanyi TF, Flautner L. Pancreatic head mass: what can be done? Classification: the clinical point of view. JOP 2000; 1 (Suppl. 03) 85-90
55 Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging. Radiology 1999; 212 (01) 213-218
56 Sandrasegaran K, Nutakki K, Tahir B, Dhanabal A, Tann M, Cote GA. Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer. AJR. Am J Roentgenol 2013; 201 (05) 1002-1008
57 Fritscher-Ravens A, Brand L, Knöfel WT. et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 2002; 97 (11) 2768-2775
58 Barthet M, Portal I, Boujaoude J, Bernard JP, Sahel J. Endoscopic ultrasonographic diagnosis of pancreatic cancer complicating chronic pancreatitis. Endoscopy 1996; 28 (06) 487-491
59 Ardengh JC, Lopes CV, Campos AD, Pereira de Lima LF, Venco F, Módena JL. Endoscopic ultrasound and fine needle aspiration in chronic pancreatitis: differential diagnosis between pseudotumoral masses and pancreatic cancer. JOP 2007; 8 (04) 413-421
60 Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 2005; 62 (05) 728-736, quiz 751, 753
61 Krishna NB, Mehra M, Reddy AV, Agarwal B. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc 2009; 70 (01) 70-79