Cystic neoplasms of the pancreas: problems in differential diagnosis.
From 1970 to 1990 we observed 18 patients with histologically proven pancreatic cystic tumors. The average duration of symptoms prior to diagnosis was 14.1 months. A presumptive diagnosis was made preoperatively in nine patients. CT-guided fine needle cytology performed in three cases correctly showed a benign lesion in one patient and malignancy in two patients. Amylase and tumoral marker levels (CEA, CA19-9) were low in cystic fluid of two patients with cystadenomas who underwent preoperative percutaneous aspiration. Intraoperative biopsy of the cystic wall failed to detect epithelial lining in two cases; one patient had internal drainage for cystadenocarcinoma mistaken for pancreatic pseudocyst. Sixteen patients underwent surgery, two of whom died. Of the seven patients with a malignant condition, resection for cure was performed on three. The preoperative diagnosis of these very rare tumors remains difficult. Fine-needle cytology and cystic fluid examination may be a promising technique, but resection of all suspected lesions, whenever possible, is the procedure of choice for diagnosis and treatment.
Sperti
C
C
Department of Surgery, University of Padua, Italy.
Cappellazzo
F
F
Pasquali
C
C
Militello
C
C
Catalini
S
S
Bonadimani
B
B
Pedrazzoli
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D001707:Biopsy, Needle; D002272:Carcinoembryonic Antigen / Q000097:blood; D002648:Child; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D011300:Preoperative Care; D015641:Radiography, Interventional; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D015295:Antigens, Tumor-Associated, Carbohydrate; D002272:Carcinoembryonic Antigen; D000681:Amylases