The pancreatographic appearance and the clinical presentation of ten patients presenting with adenocarcinoma of the head of the pancreas coexisting with chronic pancreatitis were compared with those of 45 patients with chronic pancreatitis (CP), without malignancy, investigated at the same time period. All ten patients, had typical pancreatographic findings of CP, combined with an elongated narrowing of the duct of Wirsung. Marked localized irregularity of the adjacent main duct and of side branches were found in all ten patients. Such findings were not detected in the other 45 patients with CP only. Ultrasonography or computed tomography have detected a definite pancreatic mass in only five of these patients, and in six patients with CP without malignancy. It is concluded that endoscopic retrograde cholangiopancreatography is highly accurate in detecting pancreatic cancer coexisting with CP. It is primarily helpful in elderly patients having severe degrees of CP to rule out cancer.
Cancer 65893-896, 1990.
ANCREATIC CANCER (PCA) was found in 2% to 24%
P of patients with chronic pancreatitis (CP). Controversy remains whether there is an etiologic relationship between PCA and CP or whether both originate from a common cause. The diagnosis of PCA in patients with CP is extremely difficult because both anomalies have similar clinical presentations and markedly overlapping findings in imaging ~t u d i e s . ~-~ Therefore, the diagnosis of PCA coexisting with CP is frequently made during laparotomy. An improved preoperative diagnosis of PCA in patients with CP might prevent unnecessary surgery and indicate a nonsurgical therapeutic approach. Endoscopic retrograde cholangiopancreatography (ERCP) has been found as a valuable test in both
The following study assesses the accuracy of pancreatographic findings in ERCP in the diagnosis PCA in patients with CP.