Plea to radiologists: Please consider Mahvash disease when encountering an enlarged pancreas

Abstract

Radiologists play a key role in establishing an early and accurate diagnosis, especially for rare diseases. Mahvash disease (OMIM 619290) is an autosomal recessive hereditary disease caused by inactivating mutations of the glucagon receptor and its main clinical consequences are pancreatic neuroendocrine tumors and in some cases, porto-sinusoidal vascular disease and portal hypertension. Untreated Mahvash disease can be lethal. The diagnosis of Mahvash disease has almost always been delayed in the past due to radiologists’ unawareness of or unfamiliarity with the unique imaging features of Mahvash disease which are moderately to enormously enlarge pancreas with preserved pancreas contour and parenchyma without vascular involvement or lymphadenopathy. These features help differentiate Mahvash disease from other etiologies of diffusely enlarged pancreas such as diffuse pancreatic ductal carcinoma, diffuse pancreatic lymphoma, and autoimmune pancreatitis. Invoking Mahvash disease in the differential diagnosis of an enlarged pancreas has recently been shown to facilitate early diagnosis. To prevent missing the diagnosis of this significant disease, I sincerely ask radiologists to consider Mahvash disease in their differential diagnoses of diffusely enlarged pancreas.

Keywords: Mahvash disease; Pancreas imaging; Enlarged pancreas; Pancreatic ductal carcinoma; Pancreatic lymphoma; Autoimmune pancreatitis

Core Tip: Mahvash disease is a potentially lethal, autosomal recessive hereditary disease of pancreatic neuroendocrine tumors and inborn error of metabolism. The diagnosis of Mahvash disease has been delayed in the past largely due to radiologists’ unawareness of or unfamiliarity with the unique imaging features of Mahvash disease. On the other hand, Mahvash disease can be readily diagnosed once its imaging features are appreciated. To prevent missing the diagnosis of this interesting disease, radiologists should consider Mahvash disease in their differential diagnoses of diffusely enlarged pancreas.