Case Report
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2005; 11(32): 5075-5078
Published online Aug 28, 2005. doi: 10.3748/wjg.v11.i32.5075
Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis
Ting-Kai Leung, Chi-Ming Lee, Fong-Chieh Wang, Hsin-Chi Chen, Hung-Jung Wang
Ting-Kai Leung, Chi-Ming Lee, Fong-Chieh Wang, Hsin-Chi Chen, Hung-Jung Wang, Department of Diagnostic Radiology, Taipei Medical University Hospital, Taiwan; Department of Internal Medicine, Taipei Medical University Hospital, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Chi-Ming Lee, Department of Diagnostic Radiology, Taipei Medical University Hospital, 252, Wu Hsing Street, Taipei 110, Taiwan, China. yyrubber2002@yahoo.com.tw
Telephone: +886-2-27372181-1131 Fax: +886-2-23780943
Received: March 12, 2005
Revised: April 5, 2005
Accepted: April 9, 2005
Published online: August 28, 2005
Abstract

Chronic pancreatitis is a relatively common disease. We encountered two different cases of belatedly demonstrated pancreatic carcinoma featuring underlying chronic pancreatitis. The first case was one that was highly suspected as that of a malignancy based upon imaging study, but unfortunately, it could not be confirmed by intra-operative cytology at that time. Following this, the surgeon elected to perform only conservative bypass surgery for obstructive biliary complication. Peritoneal carcinomatosis was later noted and the patient finally died. The second case, a malignant mucinous neoplasm, was falsely diagnosed as a pseudocyst, based upon the lesion’s sonographic appearance and associated elevated serum amylase levels. After suffering repeated hemoptysis, the patient was found to exhibit lung metastasis and peritoneal seeding. We reviewed some of the literature, including those studies discussing chronic pancreatitis predisposing to a malignant change. These two case analyses illustrate clearly that the diagnosis for such conditions, which is simply based upon imagery or pathological considerations may end up being one of a mistaken malignancy. Some of our suggestions for the treatment of such malignancies as revealed herein include, total pancreatomy for univocal mass lesion, and needle aspiration of lesion-contained tissue for amylase, CA199 and CEA levels for a suspicious cystic pancreatic mass.

Keywords: Mucinous cystic neoplasm; Pancreatic carcinoma; Pseudocyst; Pancreatic adenocarcinoma; Chronic pancreatitis