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

Research output: Contribution to journalReview article

12 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)5075-5078
Number of pages4
JournalWorld Journal of Gastroenterology
Volume11
Issue number32
Publication statusPublished - Aug 28 2005

Fingerprint

Chronic Pancreatitis
Pancreatic Neoplasms
Amylases
Neoplasms
Hemoptysis
Imagery (Psychotherapy)
Needles
Cell Biology
Neoplasm Metastasis
Carcinoma
Lung
Serum
Therapeutics

Keywords

  • Chronic pancreatitis
  • Mucinous cystic neoplasm
  • Pancreatic adenocarcinoma
  • Pnacreatic carcinoma
  • Pseudocyst

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Leung, T. K., Lee, C. M., Wang, F. C., Chen, H. C., & Wang, H. J. (2005). Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis. World Journal of Gastroenterology, 11(32), 5075-5078.

Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis. / Leung, Ting Kai; Lee, Chi Ming; Wang, Fong Chieh; Chen, Hsin Chi; Wang, Hung Jung.

In: World Journal of Gastroenterology, Vol. 11, No. 32, 28.08.2005, p. 5075-5078.

Research output: Contribution to journalReview article

Leung, TK, Lee, CM, Wang, FC, Chen, HC & Wang, HJ 2005, 'Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis', World Journal of Gastroenterology, vol. 11, no. 32, pp. 5075-5078.
Leung, Ting Kai ; Lee, Chi Ming ; Wang, Fong Chieh ; Chen, Hsin Chi ; Wang, Hung Jung. / Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis. In: World Journal of Gastroenterology. 2005 ; Vol. 11, No. 32. pp. 5075-5078.
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AB - 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.

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