bllernatimtaI 3-ournalofPancreatology, vol. 12, no. 3:297-303, December1992 9 Copyright1992by The HumanaPress Inc. All rights af any naturewhatsoeverreserved. 0t69-4197/92/12/3:297-303/$2.00
Case
Report
Pancreatic Carcinoma Associated with Chronic Calcifying Pancreatitis Koji Yamaguchi Department of Surgery L Kyushu University Faculty of Medicine, Fukuoka, Japan
Summary A total of 160 Japanese patients with pancreatic carcinoma were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991o Four of these patients had an accompanying pancreatic calcification with a 2.5% incidence of pancreatic carcinoma. Those four patients consisted of 52, 75, 75, and 82 year-old men. Three complained of jaundice and another developed an abdominal mass. Two of the four patients were diabetic and had a past history of heavy alcoholic intake. Three pancreatic carcinomas were located in the head of the pancreas, including two with multiple small calcifications in the entire pancreas and one with a solitary large calcification in the head. Another pancreas body carcinoma was associated with diffuse small calcifications both in and distal to the mass. In three pancreatic carcinomas, pancreatic calcification was demonstrated proimal and distal to the pancreatic carcinomas. All four patients died within 14 months after the clinical diagnosis of pancreatic carcinoma. Although we cannot draw a definitive conclusion on the link because of the limited number of cases in this retrospective study, followup studies on patients with chronic calcifying pancreatitis are needed for clarification~
KeyWords:
Pancreatic carcinoma; chronic calcifying pancreatitis.
Introduction
the possible keys to an improvement of the poor clinical outcome include the early diagnosis o f pancreatic carcinoma, radical operation, multidisciplinary treatment, and the determination of highrisk group, among others. If high-risk groups can be determined, the screening o f such groups may yield a greater early detection rate of pancreatic carcinoma, as in patients with liver cirrhosis and a high serum level of alpha-fetoprotein o f liver cell carcinoma. Various conditions have been proposed that could be associated with pancreatic carcinoma (1); the high consumption o f margarine on sliced
The incidence of pancreatic carcinoma is increasing all over the world, including Japan (1). Despite the recent progress in diagnostic and therapeutic modalities, the clinical course of patients with pancreatic carcinoma remains dismal (1,2). Some of Received January 30, 1992; Revised March 7, 1992; Accepted April 13, 1992 Correspondence to: Department of Surgery I, Kyushu University Faculty of Medicine, 3-t-1 Maidashi, Higashi-ku, Fukuoka 812, Japan
International Journal of PancreatoIogy
207
Volume 12, 1992
298
Yamaguchi
Table 1 Clinical Features of Four Japanese Patients with Pancreatic Carcinoma and Pancreatic Calcification Chief Calcification Site of Relationship between No of Alcoholism Site Characteristics tumor calcification and mass case Age/sex complaint DM Abdominal Calcification was noted mass No No Tail Mulitple, Small Body two years previously 1 52/M Both lesions were noted Jaundice No No Head Solitary, Large Head concomitantly 2 75/M Both lesions were noted Jaundice Yes Yes Diffuse Mulitple, Small Head concomitantly 3 75/M Calcification was noted 4 82/M Jaundice Yes Yes Diffuse Mulitple, Small Head 20 years previously DM: diabetes mellitus.
bread, or a large amount of pasta, the heavy use of professional makeup, heavy tobacco smokers, coffee consumption, fat intake, diabetes mellitus, those who undergo a tonsillectomy or partial gastrectomy, and so on. Chronic calcifying pancreatitis has also been reported to accompany pancreatic carcinoma. We reviewed a total of 160 patients with pancreatic carcinoma who were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991. Four of these patients had pancreatic carcinoma as well as chronic calcifying pancreatitis. We herein review the clinical features of these four patients in order to reappraise the relationship between chronic calcifying pancreatitis and pancreatic carcinoma. Materials
and
Methods
A total of 160 patients with pancreatic carcinoma were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991. Four of those patients had an associated pancreatic calcification with a 2.5% incidence o f pancreatic carcinoma (Table 1). Clinical charts were reviewed in all four patients. Radiologic findings were also reviewed as follows; abdominal stout film in four, upper gastrointestinal X-ray series in three, ultrasonography in four, computed tomography in four, and angiography in three patients. Three patients underwent a laparotomy, whereas the other patient was unable to tolerate a laparotomy. The clinical followup was International Journal of Pancreatology
updated as of December 1991 and followup information was available for all four patients. Autopsy findings were available on only one patient~ Case
Reports
Case 1 (S1-289-81) Two years prior to the present admission, multiple small calcifications had been noted in the tail o f the pancreas in a 52-year-old Japanese man. The patient presented with abdominal pain and abdominal mass in the epigastrium. The patient was not diabetic. There was no history of abdominal trauma. The serum carcinoembryonic antigen (CEA) level was 2.1 ng/ mL (
Case
Report
Pancreatic Carcinoma Associated with Chronic Calcifying Pancreatitis Koji Yamaguchi Department of Surgery L Kyushu University Faculty of Medicine, Fukuoka, Japan
Summary A total of 160 Japanese patients with pancreatic carcinoma were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991o Four of these patients had an accompanying pancreatic calcification with a 2.5% incidence of pancreatic carcinoma. Those four patients consisted of 52, 75, 75, and 82 year-old men. Three complained of jaundice and another developed an abdominal mass. Two of the four patients were diabetic and had a past history of heavy alcoholic intake. Three pancreatic carcinomas were located in the head of the pancreas, including two with multiple small calcifications in the entire pancreas and one with a solitary large calcification in the head. Another pancreas body carcinoma was associated with diffuse small calcifications both in and distal to the mass. In three pancreatic carcinomas, pancreatic calcification was demonstrated proimal and distal to the pancreatic carcinomas. All four patients died within 14 months after the clinical diagnosis of pancreatic carcinoma. Although we cannot draw a definitive conclusion on the link because of the limited number of cases in this retrospective study, followup studies on patients with chronic calcifying pancreatitis are needed for clarification~
KeyWords:
Pancreatic carcinoma; chronic calcifying pancreatitis.
Introduction
the possible keys to an improvement of the poor clinical outcome include the early diagnosis o f pancreatic carcinoma, radical operation, multidisciplinary treatment, and the determination of highrisk group, among others. If high-risk groups can be determined, the screening o f such groups may yield a greater early detection rate of pancreatic carcinoma, as in patients with liver cirrhosis and a high serum level of alpha-fetoprotein o f liver cell carcinoma. Various conditions have been proposed that could be associated with pancreatic carcinoma (1); the high consumption o f margarine on sliced
The incidence of pancreatic carcinoma is increasing all over the world, including Japan (1). Despite the recent progress in diagnostic and therapeutic modalities, the clinical course of patients with pancreatic carcinoma remains dismal (1,2). Some of Received January 30, 1992; Revised March 7, 1992; Accepted April 13, 1992 Correspondence to: Department of Surgery I, Kyushu University Faculty of Medicine, 3-t-1 Maidashi, Higashi-ku, Fukuoka 812, Japan
International Journal of PancreatoIogy
207
Volume 12, 1992
298
Yamaguchi
Table 1 Clinical Features of Four Japanese Patients with Pancreatic Carcinoma and Pancreatic Calcification Chief Calcification Site of Relationship between No of Alcoholism Site Characteristics tumor calcification and mass case Age/sex complaint DM Abdominal Calcification was noted mass No No Tail Mulitple, Small Body two years previously 1 52/M Both lesions were noted Jaundice No No Head Solitary, Large Head concomitantly 2 75/M Both lesions were noted Jaundice Yes Yes Diffuse Mulitple, Small Head concomitantly 3 75/M Calcification was noted 4 82/M Jaundice Yes Yes Diffuse Mulitple, Small Head 20 years previously DM: diabetes mellitus.
bread, or a large amount of pasta, the heavy use of professional makeup, heavy tobacco smokers, coffee consumption, fat intake, diabetes mellitus, those who undergo a tonsillectomy or partial gastrectomy, and so on. Chronic calcifying pancreatitis has also been reported to accompany pancreatic carcinoma. We reviewed a total of 160 patients with pancreatic carcinoma who were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991. Four of these patients had pancreatic carcinoma as well as chronic calcifying pancreatitis. We herein review the clinical features of these four patients in order to reappraise the relationship between chronic calcifying pancreatitis and pancreatic carcinoma. Materials
and
Methods
A total of 160 patients with pancreatic carcinoma were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991. Four of those patients had an associated pancreatic calcification with a 2.5% incidence o f pancreatic carcinoma (Table 1). Clinical charts were reviewed in all four patients. Radiologic findings were also reviewed as follows; abdominal stout film in four, upper gastrointestinal X-ray series in three, ultrasonography in four, computed tomography in four, and angiography in three patients. Three patients underwent a laparotomy, whereas the other patient was unable to tolerate a laparotomy. The clinical followup was International Journal of Pancreatology
updated as of December 1991 and followup information was available for all four patients. Autopsy findings were available on only one patient~ Case
Reports
Case 1 (S1-289-81) Two years prior to the present admission, multiple small calcifications had been noted in the tail o f the pancreas in a 52-year-old Japanese man. The patient presented with abdominal pain and abdominal mass in the epigastrium. The patient was not diabetic. There was no history of abdominal trauma. The serum carcinoembryonic antigen (CEA) level was 2.1 ng/ mL (
