Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis

Abstract

Chronic pancreatitis is a relatively common disease. We enco un tered tw o d if f erent c a s es o f bel atedly demonstrated pancreatic carcinoma featuring underlying chronic pancreatitis. The first case was one that was highly suspected as that of a malignancy based upon imaging study, but unfortunately, it could not be confirmed by intra-operative cytology at that time. Following this, the surgeon elected to perform only conservative bypass surgery for obstructive biliary complication. Peritoneal carcinomatosis was later noted and the patient finally died. The second case, a malignant mucinous neoplasm, was falsely diagnosed as a pseudocyst, based upon the lesion's sonographic appearance and associated elevated serum amylase levels. After suffering repeated hemoptysis, the patient was found to exhibit lung metastasis and peritoneal seeding. We reviewed some of the literature, including those studies discussing chronic pancreatitis predisposing to a malignant change. These two case analyses illustrate clearly that the diagnosis for such conditions, which is simply based upon imagery or pathological considerations may end up being one of a mistaken malignancy. Some of our suggestions for the treatment of such malignancies as revealed herein include, total pancreatomy for univocal mass lesion, and needle aspiration of lesion-contained tissue for amylase, CA199 and CEA levels for a suspicious cystic pancreatic mass.

Elevated Lysosome-Associated Protein Transmembrane-4β-35 is an Independent Prognostic Marker in Pancreatic Carcinoma

“…25 Markers for pancreatic cancer have been identified; serum CA19-9 is regarded as a reliable test for the detection of pancreatobiliary malignancy but does not reliably detect early, small, pancreatic cancers. 26 As far as we are aware, the present study is the first to demonstrate a relationship between the clinicopathological characteristics of pancreatic carcinoma and the prognostic significance of LAPTM4B-35 protein through semiquantitative immunohisto chemistry. LAPTM4B-35 protein was present in a large percentage of pancreatic carcinoma tissue samples and high LAPTM4B-35 staining was significantly correlated with tumour stage, degree of differentiation and pathological stage, but not with age, gender, metastasis or node stage, tumour location vascular invasion or serum CA19-9 level.…”

Dysbindin as a novel biomarker for pancreatic ductal adenocarcinoma identified by proteomic profiling

“…However, carbohydrate antigen 19–9 (CA 19–9) is still currently the only serum biomarker which has been widely used for detection of PDAC; however, this approach is frustrating in regard to both specificity and sensitivity . It is reported that 40% of chronic pancreatitis (CP) patients and 70% benign biliary obstruction (BBO) patients have elevated CA19‐9 levels, making it difficult to discriminate PDAC from CP or BBO. Hence, the efficiency of CA19‐9 reduced but we can complement the specificity and sensitivity of CA19‐9 in combination with other biomarkers …”

Factors influencing blood tumor marker concentrations in the absence of neoplasia

“…Inflammatory processes or necrosis of these organs can release significant amounts of CEA and its concentration may raise above the URL. High concentrations of this TM have been reported in pancreatitis [112], diverticulitis [113], and peptic ulcer [114], where the levels may rise to up to four or five times the URL. Inflammatory bowel disease has been associated with an increased number of false positives, reaching values four to eight times the URL in severe cases [115].…”