Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1997 Sep;73(863):543–548. doi: 10.1136/pgmj.73.863.543

Chronic pancreatitis and pancreatic carcinoma.

J D Evans 1, D G Morton 1, J P Neoptolemos 1
PMCID: PMC2431435  PMID: 9373592

Abstract

The differential diagnosis between pancreatic cancer and chronic pancreatitis is very important as the management and prognosis of these two diseases is different. In most patients with pancreatic disease, the diagnosis can be established but there is a subgroup of patients in whom it is difficult to differentiate between these conditions because the clinical presentation is often similar and currently available diagnostic tests may be unable to distinguish between an inflammatory or neoplastic pancreatic mass. This paper reviews the aetiology, pathology and clinical features of these diseases and discusses the limitations of conventional diagnostic methods and how newer techniques may be of value in the differential diagnosis.

Full text

PDF
543

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beger H. G., Büchler M., Bittner R. The duodenum preserving resection of the head of the pancreas (DPRHP) in patients with chronic pancreatitis and an inflammatory mass in the head. An alternative surgical technique to the Whipple operation. Acta Chir Scand. 1990 Apr;156(4):309–315. [PubMed] [Google Scholar]
  2. Bockman D. E., Buchler M., Malfertheiner P., Beger H. G. Analysis of nerves in chronic pancreatitis. Gastroenterology. 1988 Jun;94(6):1459–1469. doi: 10.1016/0016-5085(88)90687-7. [DOI] [PubMed] [Google Scholar]
  3. Bramhall S. R., Allum W. H., Jones A. G., Allwood A., Cummins C., Neoptolemos J. P. Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg. 1995 Jan;82(1):111–115. doi: 10.1002/bjs.1800820137. [DOI] [PubMed] [Google Scholar]
  4. Compagno J., Oertel J. E. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol. 1978 Mar;69(3):289–298. doi: 10.1093/ajcp/69.1.289. [DOI] [PubMed] [Google Scholar]
  5. Cotton P. B. ERCP. Gut. 1977 Apr;18(4):316–341. doi: 10.1136/gut.18.4.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dutta S. K., Miller P. A., Greenberg L. B., Levander O. A. Selenium and acute alcoholism. Am J Clin Nutr. 1983 Nov;38(5):713–718. doi: 10.1093/ajcn/38.5.713. [DOI] [PubMed] [Google Scholar]
  7. Falk R. T., Pickle L. W., Fontham E. T., Correa P., Fraumeni J. F., Jr Life-style risk factors for pancreatic cancer in Louisiana: a case-control study. Am J Epidemiol. 1988 Aug;128(2):324–336. doi: 10.1093/oxfordjournals.aje.a114972. [DOI] [PubMed] [Google Scholar]
  8. Friess H., Langhans J., Ebert M., Beger H. G., Stollfuss J., Reske S. N., Büchler M. W. Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography. Gut. 1995 May;36(5):771–777. doi: 10.1136/gut.36.5.771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. George D. H., Murphy F., Michalski R., Ulmer B. G. Serous cystadenocarcinoma of the pancreas: a new entity? Am J Surg Pathol. 1989 Jan;13(1):61–66. doi: 10.1097/00000478-198901000-00009. [DOI] [PubMed] [Google Scholar]
  10. Gordis L., Gold E. B. Epidemiology of pancreatic cancer. World J Surg. 1984 Dec;8(6):808–821. doi: 10.1007/BF01656020. [DOI] [PubMed] [Google Scholar]
  11. Graham R. A., Bankoff M., Hediger R., Shaker H. Z., Reinhold R. B. Fine-needle aspiration biopsy of pancreatic ductal adenocarcinoma: loss of diagnostic accuracy with small tumors. J Surg Oncol. 1994 Feb;55(2):92–94. doi: 10.1002/jso.2930550206. [DOI] [PubMed] [Google Scholar]
  12. Haddock G., Carter D. C. Aetiology of pancreatic cancer. Br J Surg. 1990 Oct;77(10):1159–1166. doi: 10.1002/bjs.1800771025. [DOI] [PubMed] [Google Scholar]
  13. Iguchi H., Sugano K., Fukayama N., Ohkura H., Sadamoto K., Ohkoshi K., Seo Y., Tomoda H., Funakoshi A., Wakasugi H. Analysis of Ki-ras codon 12 mutations in the duodenal juice of patients with pancreatic cancer. Gastroenterology. 1996 Jan;110(1):221–226. doi: 10.1053/gast.1996.v110.pm8536860. [DOI] [PubMed] [Google Scholar]
  14. Inokuma T., Tamaki N., Torizuka T., Magata Y., Fujii M., Yonekura Y., Kajiyama T., Ohshio G., Imamura M., Konishi J. Evaluation of pancreatic tumors with positron emission tomography and F-18 fluorodeoxyglucose: comparison with CT and US. Radiology. 1995 May;195(2):345–352. doi: 10.1148/radiology.195.2.7724751. [DOI] [PubMed] [Google Scholar]
  15. Jaakkola M., Nordback I. Pancreatitis in Finland between 1970 and 1989. Gut. 1993 Sep;34(9):1255–1260. doi: 10.1136/gut.34.9.1255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Johnson C. D., Hosking S. National statistics for diet, alcohol consumption, and chronic pancreatitis in England and Wales, 1960-88. Gut. 1991 Nov;32(11):1401–1405. doi: 10.1136/gut.32.11.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Klöppel G., Lohse T., Bosslet K., Rückert K. Ductal adenocarcinoma of the head of the pancreas: incidence of tumor involvement beyond the Whipple resection line. Histological and immunocytochemical analysis of 37 total pancreatectomy specimens. Pancreas. 1987;2(2):170–175. [PubMed] [Google Scholar]
  18. Klöppel G., Maillet B. Histological typing of pancreatic and periampullary carcinoma. Eur J Surg Oncol. 1991 Apr;17(2):139–152. [PubMed] [Google Scholar]
  19. Lankisch P. G., Brauneis J., Otto J., Göke B. Pancreolauryl and NBT-PABA tests. Are serum tests more practicable alternatives to urine tests in the diagnosis of exocrine pancreatic insufficiency? Gastroenterology. 1986 Feb;90(2):350–354. [PubMed] [Google Scholar]
  20. Levison D. A. Carcinoma of the pancreas. J Pathol. 1979 Dec;129(4):203–223. doi: 10.1002/path.1711290406. [DOI] [PubMed] [Google Scholar]
  21. Lewandrowski K. B., Southern J. F., Pins M. R., Compton C. C., Warshaw A. L. Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma. Ann Surg. 1993 Jan;217(1):41–47. doi: 10.1097/00000658-199301000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lillemoe K. D., Cameron J. L., Kaufman H. S., Yeo C. J., Pitt H. A., Sauter P. K. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann Surg. 1993 May;217(5):447–457. doi: 10.1097/00000658-199305010-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Lowenfels A. B., Maisonneuve P., Cavallini G., Ammann R. W., Lankisch P. G., Andersen J. R., Dimagno E. P., Andrén-Sandberg A., Domellöf L. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med. 1993 May 20;328(20):1433–1437. doi: 10.1056/NEJM199305203282001. [DOI] [PubMed] [Google Scholar]
  24. Lynch H. T., Voorhees G. J., Lanspa S. J., McGreevy P. S., Lynch J. F. Pancreatic carcinoma and hereditary nonpolyposis colorectal cancer: a family study. Br J Cancer. 1985 Aug;52(2):271–273. doi: 10.1038/bjc.1985.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Malfertheiner P., Büchler M., Stanescu A., Ditschuneit H. Pancreatic morphology and function in relationship to pain in chronic pancreatitis. Int J Pancreatol. 1987 Feb;2(1):59–66. doi: 10.1007/BF02788349. [DOI] [PubMed] [Google Scholar]
  26. Morohoshi T., Held G., Klöppel G. Exocrine pancreatic tumours and their histological classification. A study based on 167 autopsy and 97 surgical cases. Histopathology. 1983 Sep;7(5):645–661. doi: 10.1111/j.1365-2559.1983.tb02277.x. [DOI] [PubMed] [Google Scholar]
  27. Motojima K., Urano T., Nagata Y., Shiku H., Tsurifune T., Kanematsu T. Detection of point mutations in the Kirsten-ras oncogene provides evidence for the multicentricity of pancreatic carcinoma. Ann Surg. 1993 Feb;217(2):138–143. doi: 10.1097/00000658-199302000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Müller M. F., Meyenberger C., Bertschinger P., Schaer R., Marincek B. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology. 1994 Mar;190(3):745–751. doi: 10.1148/radiology.190.3.8115622. [DOI] [PubMed] [Google Scholar]
  29. Pour P. M., Sayed S., Sayed G. Hyperplastic, preneoplastic and neoplastic lesions found in 83 human pancreases. Am J Clin Pathol. 1982 Feb;77(2):137–152. doi: 10.1093/ajcp/77.2.137. [DOI] [PubMed] [Google Scholar]
  30. Sarles H., Bernard J. P., Gullo L. Pathogenesis of chronic pancreatitis. Gut. 1990 Jun;31(6):629–632. doi: 10.1136/gut.31.6.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Schmiegel W., Burchert M., Kalthoff H., Roeder C., Bützow G., Grimm H., Kremer B., Soehendra N., Schreiber H. W., Thiele H. G. Immunochemical characterization and quantitative distribution of pancreatic stone protein in sera and pancreatic secretions in pancreatic disorders. Gastroenterology. 1990 Nov;99(5):1421–1430. doi: 10.1016/0016-5085(90)91171-2. [DOI] [PubMed] [Google Scholar]
  32. Semelka R. C., Ascher S. M. MR imaging of the pancreas. Radiology. 1993 Sep;188(3):593–602. doi: 10.1148/radiology.188.3.8351317. [DOI] [PubMed] [Google Scholar]
  33. Shorten S. D., Hart W. R., Petras R. E. Microcystic adenomas (serous cystadenomas) of pancreas. A clinicopathologic investigation of eight cases with immunohistochemical and ultrastructural studies. Am J Surg Pathol. 1986 Jun;10(6):365–372. doi: 10.1097/00000478-198606000-00001. [DOI] [PubMed] [Google Scholar]
  34. Smits N. J., Reeders J. W. Current applicability of duplex Doppler ultrasonography in pancreatic head and biliary malignancies. Baillieres Clin Gastroenterol. 1995 Mar;9(1):153–172. doi: 10.1016/0950-3528(95)90075-6. [DOI] [PubMed] [Google Scholar]
  35. Southorn P. A., Powis G. Free radicals in medicine. II. Involvement in human disease. Mayo Clin Proc. 1988 Apr;63(4):390–408. doi: 10.1016/s0025-6196(12)64862-9. [DOI] [PubMed] [Google Scholar]
  36. Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990 Apr;85(4):350–355. [PubMed] [Google Scholar]
  37. Warshaw A. L. Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis. Am J Surg. 1985 Apr;149(4):563–569. doi: 10.1016/s0002-9610(85)80057-x. [DOI] [PubMed] [Google Scholar]
  38. Warshaw A. L. Implications of peritoneal cytology for staging of early pancreatic cancer. Am J Surg. 1991 Jan;161(1):26–30. doi: 10.1016/0002-9610(91)90356-i. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES