Adenocarcinoma of the uncinate process of the pancreas: MDCT patterns of local invasion and clinical features at presentation

Objective To compare the multidetector CT (MDCT) patterns of local invasion and clinical findings at presentation in patients with adenocarcinoma of the uncinate process of the pancreas to patients with adenocarcinomas in the non-uncinate head of the pancreas. Methods We evaluated the two cohorts for common duct and pancreatic duct dilatation, mesenteric vascular encasement, root of mesentery invasion, perineural invasion and duodenal invasion. In addition, we compared the clinical findings at presentation in both groups. Results Common duct (P<0.001) and pancreatic duct dilatation (P=0.001) were significantly less common in uncinate process adenocarcinomas than in the non-uncinate head of the pancreas. Clinical findings of jaundice (P=0.01) and pruritis (P=0.004) were significantly more common in patients with lesions in the non-uncinate head of the pancreas. Superior mesenteric artery encasement (P=0.02) and perineural invasion (P=0.001) were significantly more common with uncinate process adenocarcinomas. Conclusion Owing to its unique anatomic location, adenocarcinomas within the uncinate process of the pancreas have significantly different patterns of both local invasion and clinical presentation compared to patients with carcinomas in the non-uncinate head of the pancreas. Key Points SMA encasement and perineural invasion were more common with uncinate process adenocarcinomas. Common bile duct and pancreatic duct dilatation were less common in uncinate process adenocarcinomas Jaundice and pruritis were more common with lesions elsewhere in the pancreatic head