Abstract
Two cases of pancreatic cancer accompanied by pseudocyst are reported. Case 1 was a 60-year-old man who was admitted to our hospital complaining of left lower abdominal discomfort. A cystic lesion, about 3 cm in diameter, was found in the pancreatic tail by ultrasonography (US) and computed tomography (CT). No signs of chronic pancreatitis were found. At operation, an elastic, hard, white tumor, about 1 cm in diameter, was felt adjacent to the cystic lesion on the duodenal side. Histologically, this tumor was a duct cell carcinoma with an adjacent pseudocyst upstream of the pancreas. Case 2 was a 57-year-old man who complained of back pain and loss of body weight. US and CT examination revealed a cystic lesion, 11×7 cm in size, in the tail of the pancreas. Histological examination of the resected speciment revealed both a duct cell carcinoma, 3 cm in size, in the body of the pancreas and a pseudocyst, 9 cm in size. Pseudocysts accompanying carcinoma are thought to develop from obstruction of the pancreatic duct by the carcinoma, followed by intraductal high pressure and disruption of ductules upstream of the pancreas. Thus, we should pay careful attention to pseudocyst of the pancreas, especially when signs of diffuse chronic inflammation cannot be found, to help identify duct cell carcinoma in the early stage. Further detailed examinations of the cyst fluid or pancreatic juice, such as cytology, tumor marker determinations, or establishment of K-ras codon 12 mutation, are needed.
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Thomas MJ, Pellegrini CA, Way LW. Usefuness of diagnostic tests for biliary obstruction. Am J Surg 1982;144:102–108.
Redman HC. Standard radiologic diagnosis and CT scanning in pancreatic cancer. Cancer 1981;47:1656–1661.
Rohrmann CA, Silvis SE, Vennes JA. The significance of pancreatic ductal obstruction in differential diagnosis of abdominal endoscopic retrograde pancreatogram. Radiology 1976; 121:311–314.
Rosch J, Keller FS. Pancreatic arteriography, transhepatic pancreatic venography, and pancreatic venous sampling in diagnosis of pancreatic cancer. Cancer 1981;47:1679–1684.
Hiraoka T. Extended radical resection of cancer of the pancreas with intraoperative radiotherapy. Clin Gastroenterol 1990;4: 985–993.
Tsuchiya R, Tsunoda T, Ishida T, Saitoh Y. Resection for cancer of the pancreas—the Japanese experience. Clin Gastroenterol 1990;4:931–939.
Russel RCG. Surgical resection for cancer of the pancreas. Clin Gastroenterol 1990;4:889–916.
Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy; 118 resections without an operable mortality. Ann Surg 1990;211:447–458.
Jones SN, Lees WR, Frost RA. Diagnosis and grading of chronic pancreatitis by morphological criteria derived by ultrasound and pancreatography. Clin Radiol 1988;39:43–48.
Axon ATR. ERCP in chronic pancreatitis. Radiol Clin North Am 1989;27:39–49.
Nigahama T, Goseki N, Inoue Y, et al. A case of pancreatic carcinoma coexistent with pancreatic pseudocyst (in Japanese). J Jpn Surg Soc 1990;91:150–153.
Sugiura Y, Sima S, Yonekawa S, et al. A pitfall in the diagnosis of pancreatic carcinoma combined with pseudocyst (in Japanese). Gastroenterol Surg 1984;7:1670–1672.
Morita M, Saisho H, Tsuchiya Y, et al. Non-surgical management of the pancreatic pseudocyst (in Japanese). J Bil Tract Pancreas 1984;5:1133–1138.
Fox NM, Ferris DO, Moertel CG, Waugh JM. Pseudocyst coexistent with pancreatic carcinoma. Ann Surg 1963;158:971–974.
Mikal S, Campbell AJA. Carcinoma of the pancreas. Diagnosis and operative criteria based on 100 consecutive autopsies. Surgery 1950;28:963–969.
Warren KW, Athanassiades S, Frederick P, Kune GA. Surgical treatment of pancreatic cysts: Review of 183 cases. Ann Surg 1966;163:886–891.
Takagi K, Ohashi I, Ohta H, et al. Classification and background of cystic lesion in the pancreas (in Japanese). Stomach Intestine 1986;21:711–725.
The Japanese Committee of Pancreatic Cancer. Research of cases with pancreatic carcinoma (1992) in Japan (in Japanese), Y. Saito (ed) Kobe, p 38, 1992.
Warshaw AL, Compton CC, Lewandrowski K, et al. Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990;212:432–445.
Talamini MA, Pitt HA, Hruban RH et al. Spectrum of cystic tumors of the pancreas. Am J Surg 1992;163:117–124.
Pyke CM, Heerden JA, Colby TV, et al. The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 1992;215:132–139.
Delcore R, Thomas JH, Forster J, Hermreck AS. Characteristics of cystic neoplasms of the pancreas and results of aggressive surgical treatment. Am J Surg 1992;164:437–442.
Tatsuya M, Iishi H, Ichii M, et al. Values of carcinoembryonic antigen, elastase 1, and carbohydrate antigen determined in aspirated pancreatic cystic fluid in the diagnosis of cysts of the pancreas. Cancer 1986;57:1836–1839.
Lewandrowski KB, Southern JF, Pins MR, et al. 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;218:41–47.
Unger PD, Danque POV, Fuchs A, Kaneko M. DNA flow cytometric evaluation of serous and mucinous cystic neoplasms of the pancreas. Arch Pathol Lab Med 1991;115:563–565.
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Kimura, W., Sata, N., Nakayama, H. et al. Pancreatic carcinoma accompanied by pseudocyst: Report of two cases. J Gastroenterol 29, 786–791 (1994). https://doi.org/10.1007/BF02349289
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DOI: https://doi.org/10.1007/BF02349289