Cystic Dystrophy In Heterotopic Pancreas Research Articles

Cystic dystrophy in heterotopic pancreas.

Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.

Cystic Dystrophy in Heterotopic Pancreas Mimicking a Gastrointestinal Stromal Tumor

Cystic dystrophy in heterotopic pancreas (CDHP) is characterized by the presence of cystic dilatation of the ectopic pancreatic ducts in heterotopic pancreas, which mostly occurs in the second portion of the duodenum [1,2].

“Duodenal dystrophy”, or “groove pancreatitis”, or “paraduodenal pancreatitis?” Does it matter which name you choose? Lessons of 76 cases

Background: The term “paraduodenal pancreatitis (PP)“ was proposed as an umbrella for cystic dystrophy in heterotopic pancreas (duodenal dystrophy,DD), paraduodenal cyst and groove pancreatitis, by reasoning that these conditions mimic pancreatic head tumors and share certain histological evidences. The reasons for amalgamation of these terms are unclear. Methods: Prospective analysis of 76 cases of DD (2004-2016), comparing 65 preoperative and 57 histopathological findings; Assessment of clinical presentation and the results of DD treatment. Results: Preoperative diagnosis was correct in all cases except one (1,9%). Patients were presented with abdominal pain(100%), weight loss(76%), vomiting(30%) and jaundice(18%). CT, MRI and endoUS were the most useful diagnostic modalities. Nine patients were treated conservatively, 35 underwent pancreaticoduodenectomies(PD), pancreatico- and cystoenterostomies(8), Nakao procedures(4), duodenum-preserving pancreatic head (DPPH) resections(5), and 14 pancreas-preserving duodenal resections(PPDR). No mortality. Full pain control was achieved after PPRDs in 93%, PDs in 83%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. In 3 PD cases only moderate pancreatitis was revealed in specimen Conclusion: The diagnosis of DD can be confidently determined by modern methods preoperatively;Early diagnosis of DD saves pancreas The efficacy of PPDR proves DD is an entity of duodenal, but not paraduodenal origin

“Duodenal dystrophy”, or “groove pancreatitis”, or “paraduodenal pancreatitis?” Does it matter which name you choose? Lessons of 76 cases.

Background: The term “paraduodenal pancreatitis (PP)“ was proposed as an umbrella for cystic dystrophy in heterotopic pancreas (duodenal dystrophy,DD), paraduodenal cyst and groove pancreatitis, by reasoning that these conditions mimic pancreatic head tumors and share certain histological evidences. The reasons for amalgamation of these terms are unclear. Methods: Prospective analysis of 76 cases of DD (2004-2016), comparing 65 preoperative and 57 histopathological findings;Assessment of clinical presentation and the results of DD treatment. Results: Preoperative diagnosis was correct in all cases except one (1,9%). Patients were presented with abdominal pain(100%), weight loss(76%), vomiting(30%) and jaundice(18%). CT, MRI and endoUS were the most useful diagnostic modalities. Nine patients were treated conservatively, 35 underwent pancreaticoduodenectomies(PD), pancreatico- and cystoenterostomies(8), Nakao procedures(4), duodenum-preserving pancreatic head (DPPH) resections(5), and 14 pancreas-preserving duodenal resections(PPDR). No mortality. Full pain control was achieved after PPRDs in 93%, PDs in 83%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. In 3 PD cases only moderate pancreatitis was revealed in specimen. Conclusion: The diagnosis of DD can be confidently determined by modern methods preoperatively;Early diagnosis of DD saves pancreas The efficacy of PPDR proves DD is an entity of duodenal, but not paraduodenal origin.

Парадуоденальний (groove) панкреатит. Термінологія, етіопатогенез, патоморфологія

Парадуоденальний, або groove панкреатит, рідкісний тип фокального хронічного запалення підшлункової залози, що переважно вражає ‘‘борозну‘‘ –анатомічний простір між дорсокраніальною частиною головки підшлункової залози, дванадцятипалою кишкою та загальною жовчною протокою. В літературі зустрічається під такими синонімами: дуоденальна дистрофія гетеротопічної підшлункової залози, панкреатична гамартома дванадцятипалої кишки, міоаденоматоз. Спірним залишається питання патогенезу парадуоденального панкреатиту. Основними етіопатогенетичними факторами захворювання є анатомічні особливості протокової системи підшлункової залози та підвищення в'язкості панкреатичного соку, які призводять до хронічного персистуючого запалення в ділянці ‘‘борозни‘‘ з наступним втягненням в патологічний процес головки підшлункової залози, двадцятипалої кишки та термінального відділу холедоха. Тяжкість диференціації groove панкреатиту з пухлинами періампулярної ділянки створює певні діагностичні труднощі для клініцистів та патоморфологів, що вимагає проведення операційного лікування для верифікації остаточного діагнозу. Дане повідомлення описує основні етіологічні, патофізіологічні та морфологічні зміни, які виникають при парадуоденальному панкреатиті.

Cystic form of paraduodenal pancreatitis (cystic dystrophy in heterotopic pancreas (CDHP)): a potential link with minor papilla abnormalities? A study in a large series.

To analyze the association between cystic dystrophy in the heterotopic pancreas (CDHP) and minor papilla abnormalities. Seventy-six patients with CDHP were retrospectively included over 14 years. Two radiologists searched for MDCT signs of CDHP (cysts and thickened intestinal wall, inflammatory changes), and minor papilla abnormalities (Santorini duct dilatation, luminal calcifications of the minor papilla). Other pancreatic abnormalities (parenchymal calcifications, main pancreatic duct dilatation) or bile duct dilatation were also analysed. CDHP was mostly located in the second part of the duodenum (71/76, 93.5 %). Median duodenal wall thickness was 20 mm (range 10-46). There were multiple cysts in 86 % (65/76, median = 3), measuring 2-60 mm. No cysts were identified in four patients (5 %). Inflammatory changes were found in 87 % (66/76). Minor papilla abnormalities were found in 37 % (28/76) and calcifications in the minor papilla without calcifications in the major papilla were only observed in three patients (4 %). Abnormalities of the pancreas and main bile duct dilatation were identified in 78 % (59/76) and 38 % (29/76). Previously described CT features were seen in most patients with CDHP. However, minor papilla abnormalities were seen in a minority of patients and, therefore, do not seem to be a predisposing factor for CDHP. Imaging features suggesting a CDHP diagnosis are confirmed in a large series. Minor papilla abnormalities do not seem to be a predisposing factor for CDHP. Most patients did not have any isolated minor papilla abnormalities.

Groove Pancreatitis: A Malignant Masquerade in the Duodenum

Groove pancreatitis is a rare form of chronic pancreatitis that has been described by several names including para-duodenal wall cyst, pancreatic hamartoma of the duodenum, cystic dystrophy of heterotopic pancreas, and myoadenomatosis. It is characterized microscopically by the presence of a pseudocyst arising from the “groove” between the duodenum, common bile duct, and pancreatic head. It is thought to be caused by functional and/or anatomical minor papilla obstruction from viscous pancreatic secretions. In turn, this leads to impaired pancreatic enzyme outflow, Brunner’s gland proliferation, and resultant pancreatitis. This often appears as a submucosal mass in the region. Thus, the differential diagnosis ranges from benign pathologies such as Brunner’s gland hyperplasia, leiomyoma, and schwannoma to malignant pathologies such as gastrointestinal stromal tumor and ampullary carcinoma. Herein, we present a case of a middle aged male smoker with a remote history of alcohol abuse that presented with one month of epigastric pain associated with bilious emesis and weight loss. Computed tomography (CT) and endoscopic ultrasound (EUS) revealed a submucosal cystic mass that was obstructing the second portion of the duodenum. Cytology demonstrated crowded groups of atypical epithelioid and spindle cells that were suspicious for a neoplasm. The patient subsequently underwent pancreaticoduodenectomy in order to relieve his duodenal obstruction, as well as to establish a definitive tissue diagnosis. Despite the use of multiple imaging modalities including CT and EUS with fine needle aspirates, the final diagnosis of groove pancreatitis was only made following resection. This case now demonstrate that groove pancreatic often mimics submucosal duodenal tumors and malignant periampullary cancers clinically, radiographically, endoscopically, and cytologically.

A solid pancreatic mass: Tumour or inflammation?

The prognosis for pancreatic cancer is poor, and early diagnosis is essential for surgical management. By comparison with its classic form, the presence of acute or chronic inflammatory signs will hinder its detection and delay its diagnosis. The atypical forms of acute pancreatitis need to be known in order to detect patients who require additional morphological investigations to search for an underlying tumour. In contrast, pseudotumoral forms of inflammation (chronic pancreatitis, cystic dystrophy in heterotopic pancreas, autoimmune pancreatitis) may simulate a cancer, and make up 5-10% of the surgical procedures for suspected cancer. Faced with these pseudotumoral masses, interpretation relies on various differentiating signs and advances in imaging.

Cystic dystrophy of heterotopic pancreas in duodenal wall

Cystic dystrophy in heterotopic pancreas is a rare, poorly understood benign disease of gastric and duodenal wall, which was described for the first time by the French authors in 1970, who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of duodenum & the head of pancreas. We report a case of 33 years old male patient with complaint of recurrent abdominal pain with the probable diagnosis of groove pancreatitis on the clinoradiological findings. Whipple surgery was done. Diagnosis of cystic dystrophy in heterotopic pancreas in duodenal wall with chronic pancreatitis was given histopathologically.

Pancreatitis del surco. Presentación de dos casos en piezas de duodenopancreatectomía

La pancreatitis del surco representa una forma segmentaria de pancreatitis crónica que afecta la región periduodenal, entre la pared duodenal y el páncreas. Esta entidad es poco frecuente y posee ciertas características clínico patológicas que permiten identificarla preoperatoriamente. Esta condición ha recibido varios nombres entre estos: distrofia quística del páncreas heterotópico, hamartoma pancreático del duodeno, quiste paraduodenal y mioadenomatosis del páncreas. Presentamos dos casos de pancreatitis del surco en piezas de duodenopancreatectomía en hombres de 39 y 50 años, ambos bebedores de alcohol. Los estudios de imagen mostraron en ambos lesiones quísticas intrapancreáticas. Histológicamente se observó engrosamiento de la mucosa duodenal, hiperplasia severa de las glándulas de Brunner, proliferación miofibroblástica con formaciones quísticas, entremezclada con tejido pancreático e inflamación crónica. Esta entidad entra en el diagnóstico diferencial de las lesiones pseudotumorales pancreáticas que pueden simular carcinoma. Groove pancreatitis is a form of chronic segmental pancreatitis affecting the periduodenal region between the duodenum and the head of the páncreas. This uncommon entity has distinct clinicopathological features which facilitate its preoperative diagnosis. It is also been known as cystic dystrophy in heterotopic páncreas, pancreatic hamartoma of the duodenum, paraduodenal cyst and adenomyomatosis of the páncreas. We present two cases of groove pancreatitis in adult males aged 39 and 50, both alcohol drinkers, who had undergone pancreatoduodenectomy. Imaging studies showed cystic intrapancreatic lesions. Histologically, a large duodenal wall with prominent myofibroblastic proliferation and cysts admixed with pancreatic tissue and cronic inflammation was seen. Groove pancreatitis may be confused with carcinoma.

“Paraduodenal” Pancreatitis: Results of Surgery on 58 Consecutives Patients from a Single Institution

Cystic dystrophy of heterotopic pancreas, groove pancreatitis, pancreatic hamartoma of the duodenum, paraduodenal wall cyst, and myoadenomatosis are all terms grouped together, from a pathological viewpoint, as definitions of paraduodenal pancreatitis (PP). The objective of the present study was to investigate the clinical characteristics, therapeutic strategies, and results in 58 patients undergoing pancreatic resection for PP. From January 1990 to December 2006 data were prospectively collected on 58 patients who were diagnosed with PP who then underwent pancreaticoduodenectomy. In this patient cohort the median age was 44.7 years; only 4 patients were women, and only 3 had non-drinker and/or non smoker habits. The overall morbidity was 18.9%, and the median hospitalization was 11 days. There were no postoperative deaths. In a median follow-up of 96.3 months, all patients noted a decrease in the pain associated with PP; 35 patients (76%) had complete disappearance of pain, whereas occasional relapsing pain occurred in the remaining 11 (24%). Patients with PP have clinical characteristics similar to those of chronic pancreatitis. The diagnostic imaging modalities of choice are ultrasonographic endoscopy and magnetic resonance cholangiopancreaticography. Based on our surgical experience, pancreaticoduodenectomy seems to be a reasonable choice of treatment in patients with PP.

Gastric cystic dystrophy in heterotopic pancreas demonstrating annular appearance

Cystic dystrophy in heterotopic pancreas (CDHP), an uncommon complication of heterotopic pancreas, occurs most often in the duodenal wall. We report a rare case of CDHP in the stomach. Preoperative diagnosis was made by upper gastrointestinal endoscopy and abdominal radiological studies. Radiological studies revealed an annular cystic appearance of CDHP, characterizing this rare entity. We describe the radiological–pathological correlation of CDHP and discuss the imaging findings.

Duodenal stenosis caused by cystic dystrophy in heterotopic pancreas: Report of a case

We herein describe the first reported case of duodenal stenosis caused by cystic dystrophy in heterotopic pancreas (CDHP) in Asia. A 63-year-old man was admitted to the hospital presenting with nausea and vomiting of 2 days' duration. Laboratory examinations showed an elevation in both the serum amylase level (275 IU/l) and white blood cell count (13 600/microl). A 3-cm-diameter tumor close against the duodenum was pointed out from the results of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP); the tumor contained a cystic and solid component. Endoscopic examinations and an upper gastrointestinal series showed stenosis of the second portion of the duodenum without any mucosal change. The tumor was considered to be located at the submucosal layer of the second duodenum. The biopsy specimen of the duodenum revealed no malignancy. We strongly doubted the presence of a malignant submucosal tumor in the duodenum based on the findings of diagnostic imaging, and a pancreaticoduodenectomy was thus performed. Histopathologically, the lesion was diagnosed to be CDHP. The postoperative course was uneventful. The patient was symptomatic but was free of any symptoms after surgery. He continues to be regularly followed up on an outpatient basis and has had no recurrence of symptoms. This case demonstrates the need to consider CDHP in the differential diagnosis as a rare cause of duodenal stenosis.

Cystic Dystrophy in Heterotopic Pancreas of the Duodenal Wall

Background: Cystic dystrophy in heterotopic pancreas (CDHP) is a rare condition. It has been recently reported as one of the etiologic obstructive factors of chronic pancreatitis. The aim of our study was to evaluate diagnosis and management of CDHP in the duodenal wall in a surgical series. Methods: We retrospectively reviewed 13 patients with available clinical data. Results: There were 11 male and 2 female patients, median age 42 years. The average duration of symptoms was 7.5 months. 6 of them (46%) were alcoholics, and 10 (75%) had signs of chronic pancreatitis. Almost all of them (12/13; 92%) revealed disabling pain, while 4 (31%) had associated jaundice. In 4 of 7 patients (57%), weight loss was observed. Most often the patients were suspected of having pancreatic head mass with or without signs of chronic pancreatitis. All patients underwent surgical treatment. Pathological examination showed the presence of cysts surrounded by inflammation and fibrosis in the duodenal wall, as well as the presence of chronic pancreatitis in the pancreas proper. Conclusions: Cystic dystrophy of the duodenal wall represents a significant proportion of patients undergoing surgery for chronic pancreatitis. Pancreatoduodenectomy is the best therapeutic option.

Cystic dystrophy of heterotopic pancreas in stomach: radiologic and pathologic correlation

Cystic dystrophy of heterotopic pancreas is a rare condition that means cystic changes of normal pancreatic tissue, placed in unusual locations, commonly in the duodenal wall. We report a case of CDHP in stomach, histologically confirmed after surgery. We show the correlation between radiological and anatomopathological findings, and also review the current literature about reported cases of this exceptional disease.

Clinical and Morphological Features of Duodenal Cystic Dystrophy in Heterotopic Pancreas

Cystic dystrophy in heterotopic pancreas (CDHP) is an uncommon complication of pancreatic heterotopia, only described in surgical series, whose natural history is not known. The aim of this study was to determine clinical and morphological features of CDHP in a medical-surgical series of patients and to ascertain the relationship of CDHP with chronic pancreatitis (CP) in the pancreas proper. All patients who had duodenal CDHP diagnosed radiologically both with CT scan and endoscopic ultrasonography between 1995 and 2004 were included. The diagnosis was confirmed by surgical specimens when available. One hundred five patients were included (91% men, 86% chronic alcoholic) with a median follow-up of 15 months. The median age at first symptoms was 46 yr. CDHP was associated with CP in the pancreas proper in 71% of patients. Presenting symptoms were pancreatic pain (91%), severe weight loss (73%), acute pancreatitis (45%), vomiting (30%), steatorrhea (23%), diabetes mellitus (20%), jaundice (13%), and upper gastrointestinal hemorrhage (5%). Cysts were multiple in 75% (median 3). The median diameter of the largest cyst was 10 mm. Endoscopy was normal in 36% of patients and showed duodenal stenosis in 52% (complete 6%, incomplete 46%). Surgical treatment was necessary in only 27% of patients (Whipple procedure 16%). CDHP may arise in patients with or without CP and with or without chronic alcoholism. Symptoms may be severe but warrant surgery in less than one-third of patients.

Chronic pancreatitis, pseudotumors and other tumor-like lesions

Chronic pancreatitis is a fibroinflammatory disease of the pancreas. Etiologically, most cases are related to alcohol abuse and smoking. Recently, gene mutations have been identified as the cause of hereditary pancreatitis. Other chronic pancreatitis types that were defined in recent years are autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) and paraduodenal pancreatitis (‘groove pancreatitis', ‘cystic dystrophy of heterotopic pancreas'). This review describes and discusses the main histological findings, the pathogenesis and the clinical features of the various types of chronic pancreatitis. In addition, pseudotumors and other tumor-like lesions are briefly mentioned.

Cystic Dystrophy of the Duodenal Wall Developing in Heterotopic Pancreas

Cystic dystrophy in heterotopic pancreas (CDHP), an uncommon but serious complication of dilatation of the ectopic pancreatic ducts of heterotopic pancreatic tissue, occurs most often in the second part of the duodenum. This disorder is difficult to diagnose and raises various therapeutic questions. The aim of this study was to evaluate the most useful procedures for investigating suspected CDHP and to consider late results after surgical treatment by pancreaticoduodenectomy (PD). This retrospective study concerned 9 patients who developed CDHP of the duodenal wall during an 18-year period (1983-2001). All patients were symptomatic and underwent PD (no postoperative deaths). Clinical presentation, imaging findings, pathological features, and follow-up were analyzed. All patients but one were male alcoholics (mean age, 48 years; range, 37-63 years). The clinical presentation was abdominal pain (n = 9) associated with vomiting (n = 6), jaundice (n = 2), and weight loss (n = 9). Upper endoscopy (n = 9) showed nonspecific inflammatory lesions with duodenal stenosis (n = 4). Retrospective analysis of computed tomographic findings (n = 9) studied specific signs of CDHP and nonspecific inflammatory changes in periduodenal space. Endoscopic ultrasonography (n = 4) and magnetic resonance cholangiopancreatography (n = 2) were the most useful investigations. Pathological findings in surgical specimens were multiple cysts located in the thickened duodenal wall (n = 9), ectopic pancreatic tissue (n = 7), fibrosis of the normal gland (n = 4), and adenocarcinoma in ectopic tissue (n = 1). During the follow-up period, 4 patients died 12, 16, 48, and 72 months after PD. The cause of death was independent of CDHP or PD, but related to persistent alcoholism in 2 cases involving chronic pancreatitis. In 1 case, the patient died of disseminated adenocarcinoma. The other 5 patients had a good result. Endoscopic ultrasonography and magnetic resonance pancreatography are the most useful investigations for the diagnosis of CDHP. Pancreaticoduodenectomy is justified after failure of medical treatment or endoscopic drainage. Late results after PD are dependent on alcoholic consumption when CDHP is associated with chronic pancreatitis.

Duodenopancreatectomy for cystic dystrophy in heterotopic pancreas of the duodenal wall

Cystic dystrophy in heterotopic pancreas (CDHP) is rare. The aim of this study was to evaluate the diagnosis, management, and follow-up of the CDHP. Between August 1990 and March 2004, 12 patients with CDHP underwent a duodenopancreatectomy. The patients were retrospectively reviewed. There were 11 men and 1 woman with a mean age of 42.4 years (range: 34-54 years). Nine patients (75%) were alcoholic and 8 patients had chronic pancreatitis. The diagnosis of CDHP was performed in 8 patients (66.6%) after the preoperative workup. Seven patient had a medical treatment with octreotid and endoscopic cystic ponction (N=3) or cystic fenestration (N=1). Recurrence of pain was noted after a mean period of 5 months. Three patients had recurrent acute pancreatitis. Duodenopancreatectomy was performed in all cases. The mortality and morbidity rate were respectively 8.3% (N=1) and 25% (N=3). Mean follow-up was 64 months (ranges: 6 - 158 months). One patient was seen 70 months later with epigastric pain and features of acute pancreatitis of the pancreatic stump due to anastomotic stenosis. The other patients were asymptomatic. Diagnosis of CDHP is difficult. After failure of medical treatment, duodenopancreatectomy can be proposed.

Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas,” “para-duodenal wall cyst,” and “groove pancreatitis”

A distinct form of chronic pancreatitis occurring predominantly in and around the duodenal wall (near the minor papilla) has been reported under various names, including cystic dystrophy of heterotopic pancreas, pancreatic hamartoma of duodenum, para-duodenal wall cyst, myoadenomatosis, and groove pancreatitis. Our experience with these lesions and the review of the literature show that these lesions have the following common characteristics: (1) The duodenal wall contains dilated ducts, some with inspissated secretions, and pseudocystic changes as well as adjacent stromal reactions including hypercellular granulation tissue, foreign-body type giant cell reaction engulfing mucoprotein material, and myofibroblastic proliferation. (2) Brunner's gland hyperplasia is typically present. (3) Dense myoid stromal proliferation, with intervening rounded lobules of pancreatic acinar tissue, creates a histologic picture reminiscent of "myoadenomatosis," "pancreatic hamartoma," or even leiomyoma in some cases. (4) Spillover of fibrosis into the adjacent pancreas and soft tissue occurs, especially in the "groove" area (between the pancreas, common bile duct and duodenum), including the region around the common bile duct. (5) Clinically, these lesions often mimic "pancreas cancer" or periampullary tumors, because of marked scarring as well as the ill-defined borders of the process. Patients with these findings are predominantly males, 40-50 years old, with a history of alcohol abuse. That the process is often centered in the region of minor papilla (and the adjacent pancreas) suggests that an anatomic variation of the ductal system may render this area particularly susceptible to the effects of alcoholic injury, and the myo-adenomatoid and cystic changes on the duodenal wall may in turn represent changes related to a localized recurrent pancreatitis. In conclusion, these clinicopathologic findings characterize a distinctive process that can be referred to as paraduodenal pancreatitis.