Is there any clinical or radiologic feature as a preoperative marker for differentiating mass-forming pancreatitis from early-stage pancreatic adenocarcinoma?

BACKGROUND/AIMS: The differential diagnosis of early-stage pancreatic cancer and mass-forming pancreatitis is still unsettled. The purpose of the present study was to define the differential feature of focal mass-forming pancreatitis and malignant mass using aspects of clinical, laboratory and imaging features on pancreatogram or computed tomography (CT). METHODOLOGY: Between April 1995 and May 2003, 15 patients confirmed as inflammatory mass after surgical resection for pancreatic mass and 21 patients with early-stage pancreatic adenocarcinoma among the patients diagnosed as pancreatic malignancy were included in our study. Hospital records, laboratory results, findings of imaging studies and pathological findings were reviewed retrospectively. RESULTS: Regarding the clinical characteristics, the history of previous pancreatitis was distinguished in group with mass-forming pancreatitis. Incidence of jaundice was higher in the group with adenocarcinoma than in the mass-forming pancreatitis group. For laboratory results, CA19-9 level and alkaline phosphatase level were significantly elevated in the malignant group. Findings such as hyperattenuation on portal venous phase of CT scans and gradual tapering stricture on pancreatogram were differential diagnostic markers between the two groups. A portion of patients with mass-forming pancreatitis demonstrated the pathologic characteristics of autoimmune pancreatitis. CONCLUSIONS: Our 9-year experience suggests that imaging findings such as attenuation pattern on the delayed phase of CT scan and tapering pattern of pancreatic ductal stricture on pancreatogram can help to differentiate mass-forming pancreatitis from early-stage pancreatic adenocarcinoma.

[A result of surgical treatment for ductal adenocarcinoma of the head of the pancreas].

BACKGROUND/AIMS: Ductal adenocarcinoma of the head of the pancreas can only be cured with pancreaticoduodenectomy. However, the prognosis after resection has been poor. This study analyzed the possible prognostic factors of resected ductal adenocarcinoma through pancreaticoduodenectomy in a single institution. METHODS: Between Oct. 1994 and May. 2002, 81 patients underwent pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Perioperative and pathologic factors were analyzed with univariate and multivariate analysis. RESULTS: The overall 5-year survival rate of the 81 patients was 10.8% with median survival of 11.8 months. Ninety-six percent of the patients were in stage IIa, IIb or III. In univariate analysis, factors favoring survival were as follows: CA19-9 antigen