{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:47:19Z","timestamp":1782604039757,"version":"3.54.5"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Drug-induced acute pancreatitis (DIP) is a recognised but underreported entity in the literature. Immunotherapy drugs have been described as one possible emerging cause, although the pathogenic mechanism is still largely unclear. To date, only a few cases have been reported, even if in recent times there is an over-increasing awareness of this pathologic entity. The imaging-based diagnosis of DIP can be difficult to establish, representing a real challenge for a radiologist, especially when the inflammatory disease appears as a focal mass suspicious for a malignancy. Case report: We herein report the case of a 71-year-old man with a known history of partially responsive lung adenocarcinoma subtype with high programmed cell death ligand 1 (PD-L1) expression, who underwent positron emission tomography (PET)\/computed tomography (CT) imaging follow-up after one year of immunotherapy. The exam revealed a stocky\/packed lesion in the pancreatic body, with increased 18F-fluorodeoxyglucose (FDG) accumulation highly suggestive of pancreatic cancer, which finally was proven to be a DIP induced by immunotherapy. Conclusion: Distinguishing between focal DIP and pancreatic neoplasm is, therefore, crucial for timely therapeutic management and prognostic stratification. A deep knowledge of possible imaging pitfalls coupled with a comprehensive clinical and laboratory assessment is pivotal to avoid any delays in diagnosis.<\/jats:p>","DOI":"10.3390\/tomography8040174","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T01:56:40Z","timestamp":1661133400000},"page":"2073-2082","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Stocky\/Packed Pancreas: A Case of Focal Drug-Induced Acute Pancreatitis Mimicking Cancer"],"prefix":"10.3390","volume":"8","author":[{"given":"Marco","family":"Di Serafino","sequence":"first","affiliation":[{"name":"Department of General and Emergency Radiology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0899-5511","authenticated-orcid":false,"given":"Roberto","family":"Ronza","sequence":"additional","affiliation":[{"name":"Department of General and Emergency Radiology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4882-5226","authenticated-orcid":false,"given":"Divina","family":"D\u2019Auria","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Fiorentino","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Oncology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0954-7857","authenticated-orcid":false,"given":"Dario","family":"Arundine","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Oncology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"De Leone","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Gastroenterology and Digestive Endoscopy, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Picascia","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Gastroenterology and Digestive Endoscopy, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8759-6518","authenticated-orcid":false,"given":"Alberto","family":"Martino","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Gastroenterology and Digestive Endoscopy, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7997-2715","authenticated-orcid":false,"given":"Enrico","family":"Crolla","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Oncological Surgery Team 1, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severo","family":"Campione","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Pathology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Guida","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Radiation Oncology, National Cancer Institute\u2013IRCCS\u2013Fondazione G. Pascale, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Molino","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Oncological Surgery Team 1, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinando","family":"Riccardi","sequence":"additional","affiliation":[{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Department of Oncology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigia","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of General and Emergency Radiology, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"},{"name":"Multidisciplinary Team for Pancreatic Cancer, \u201cAntonio Cardarelli\u201d Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e21848","DOI":"10.1097\/MD.0000000000021848","article-title":"Acute pancreatitis induced by combination chemotherapy used for the treatment of acute myeloid leukemia: A case report","volume":"99","author":"Yang","year":"2020","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101880","DOI":"10.1016\/j.canep.2020.101880","article-title":"The effect of medications associated with drug-induced pancreatitis on pancreatic cancer risk: A nested case-control study of routine Scottish data","volume":"71","author":"McDowell","year":"2021","journal-title":"Cancer Epidemiol."},{"key":"ref_3","first-page":"45","article-title":"Drug-induced acute pancreatitis: A review","volume":"15","author":"Jones","year":"2015","journal-title":"Ochsner J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.cgh.2006.11.023","article-title":"Drug-induced acute pancreatitis: An evidence-based review","volume":"5","author":"Badalov","year":"2007","journal-title":"Clin. 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