Pancreatic Carcinoma Presenting as Chronic Pancreatitis with Pseudocyst

Cheong, Oh; Jang, Hyuk Jai; Cho, Yong Pil; Kim, Yong Ho; Han, Myeng Sik; Kim, Song Cheol; Han, Duck Jong

Abstract

A pseudocyst, one of the most prominent and definitive signs of pancreatitis, can also be cause by pancreatic carcinoma. However, a pancreas carcinoma and pancreatitis are sometimes indistinguishable. Reports of a pancreatic carcinoma coexisting with pancreatitis and a pseudocyst are rare. We have experienced a case of a pancreatic carcinoma, which was misdiagnosed as chronic pancreatitis with a pseudocyst. A 31-year-old man complaining of an epigastric pain visited our hospital. Ultrasonography (US) and computed tomography (CT) revealed two cystic lesions, about 8 and 2 cm in diameter, splenic vein thrombosis and diffuse inflammatory changes in the pancreatic body and tail. The value of the tumor marker, CA19-9, was 132 U/ml. Chronic pancreatitis with pseudocyst was suspected, and a cystogastostomy and splenectomy performed. A histological examination revealed a pancreatic pseudocyst. The patient was readmitted 7 months later due to abdominal pain. The serum CA19-9 level was 544 U/ml. The CT revealed severe diffuse inflammatory changes in the pancreatic body and tail. Percutaneous CT- guided fine-needle aspiration revealed a pancreatic adenocarcinoma. The differentiation between the pseudocyst of pancreatitis and the secondary cyst caused by a pancreatic carcinoma is important but is difficult or impossible in some cases. The CT features of pseudocysts secondary to a pancreatic carcinoma are identical to those of pseudocysts in pancreatitis. Even in retrospect, our case was difficult to differentiate from pancreatitis with pseudocysts. Our results indicate that whenever pancreatic cysts are encountered in patients with unusual presentation, further examinations, including percutaneous aspiration biopsies, should be performed to exclude malignancy.