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


METHODS
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.
Lee
Hyuk
H
Department of Medicine, Sungkyunkwan University School of Medicine Seoul, Korea.
Lee
Jong Kyun
JK
Kang
Seok Seon
SS
Choi
Dongil
D
Jang
Kee-Tack
KT
Kim
Jeong Hwan
JH
Lee
Kyu Taek
KT
Paik
Seung Woon
SW
Yoo
Byung Chul
BC
Rhee
Jong Chul
JC
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000368:Aged; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012598:Sclerosis; D014057:Tomography, X-Ray Computed