A Case of Adenoequamous Carcinoma of the Pancreas with Unusual Pancreatographic Findings / 대한소화기내시경학회지

Adenosquamous carcinoma of the pancreas is a rare form of pancreatic cancer. Its biological behavior and clinical features are known to be similar to the much more common ductal adenocarcinoma or to pure squamous cell carcinoma, another rare form of pancreatic malignancy. However, the unusual manifestations of cancer, including cystic degeneration and extravasation of contrast to the mass, have also been reported. A 64-year-old man was admitted complaining of abdominal pain. An abdomial CT scan demonstrated an ovoid and cyst-like lesion in the pancreatic head and endoscopic retrograde balloon pancreatography showed segmental narrowing of the main pancreatic duct associated with extravasation of contrast into the cyst-like lesion. Under the impression of pancreatic pseudocyst with chronic pancreatitis, medical therapy including pancreatic stent insertion was given to the patient for four weeks. Finally, a laparotomy was performed due to persistent abdominal pain and a poorly demarcated mass with cystic cavity was resected. Histologic findings were consistent with adenosquamous carcinoma of the pancreas. The unusual features of this rare malignancy which led us to an errorneous initial diagnosis were emphasized.

Association of Periampullary Diverticula with Primary Choledocholithiasis but not with Secondary Choledocholithiasis / 대한소화기내시경학회지

BACKGROUND/AIMS: Several endoscopie studies found an association between periampuilary diverticula and biliary calculi, however, the results of the reports are inconsistent when considering the anatomical location of the stones. The aims of our study are to evaluate the association between periampullary diverticula and gallstones according to their location iand to clarify the origin of the common bile duct stones by analyzing the composition of the stones. METHODS: During a period of 10 months, 611 of 632 consecutive cases of endoscopic retrograde cholangiopancreatography(ERCP) were prospectively enrolled. The data of periampullary diverticula and gallstones were analyzed according to the location of the stones. The stones available were initially grouped on the basis of their grass marphology and cross-sectional appearance, and finally analyzed by quantitative infrared spectroscopy. RESULTS: Diverticula were found in 165 of 611 cases(27.0%) and there was a positive relationship between age and duodenal diverticula(p<0.01). Considering the location of the gallstones, this significance was found only in patients with common bile duct stones not associated with gallbladder or intrahepatic duct stones(p<0.001). Of these 40 cases with gallstones only in common bile duct, 32 had a history of cholecystectomy with more than a two year asymptomatic period following their surgery, and on analysis, most of the stones(30/36, 83%) were classified as brown pigment stones. Therefore, these stones were presumed to be primary common bile duct stones. On the contrary, the common bile duct stones with associated gallbladder or intrahepatic stones were identical with their paired gallbladder or intrahepatic stones in gross and cross-sectional appearance and chemical composition. They were assumed to be secondary common bile duct stones and the difference in prevalence of calculi according to the presence of diverticula was not significant. CONCLUSION: The prevalence of gallstones was significantly higher in periampullary diverticula, and considering the location and the origin of the gallstones the association between diverticula and gallstones is significant in patients with primary common bile duct stones but not with the secondary ones.