Acute pancreatitis as first episode of pancreatic cancer: a report of 17 cases

Abstract

Abstract:

ObjectiveTo investigate the clinical features, diagnosis and treatment of pancreatic cancer with acute pancreatitis as first episode.MethodsIn this study we included 17 patients of pancreatic cancer with acute pancreatitis as first episode in our hospital from January 2008 to December 2018. Clinical data were reviewed retrospectively in terms of clinical presentation, diagnosis and treatment.ResultsAll the patients were admitted to hospital diagnosed as mild acute pancreatitis. Clinical manifestations were recurrent acute abdominal pain mostly. Laboratory tests showed that tumor mar-kers elevated especially CA199. Pancreatic mass and pancreaticobiliary dilatation were shown by imaging. The patients were diagnosed pathologically through surgery. Pancreatic ductal adenocarcinoma was in 11 cases, hepatic metastatic adenocarcinoma in 2 cases. Four cases were diagnosed as adenocarcinoma by fine needle aspiration biopsy. Comprehensive treatment was performed mainly with surgery including duodenopancreatectomy in 5 cases, resection of pancreatic body and tail in 4 cases, total pancreatectomy in 2 cases, resection of metastatic hepatic lesion in 1 case, and cholecystectomy with hepatic biopsy in 1 case.ConclusionsPatients with acute pancreatitis should be cautioned to the possibility of presence of pancreatic cancer. Comprehensive consideration is suggested through medical history reviewed combined with laboratory and imaging examination for the purpose of diagnosis and treatment as early as possible.

Key words:Pancreatic cancer,Acute pancreatitis,Clinical feature

CLC Number:

WU Jingyi, LI Guojing, FEI Jian. Acute pancreatitis as first episode of pancreatic cancer: a report of 17 cases[J]. Journal of Surgery Concepts & Practice, 2020, 25(04): 326-330.

Figures/Tables3

项目	例数（%）	项目	例数（%）
临床表现		既往史
腹痛	16（94.1）	高血压史	4（23.5）
腰背部放射痛	4（23.5）	糖尿病史	1（5.9）
黄疸	4（23.5）	高脂血症史	1（5.9）
体重下降	6（35.3）	吸烟史	5（29.4）
上腹部压痛	11（64.7）	饮酒史	5（29.4）
反复发作	11（64.7）	AP严重程度分级
诱因		MAP	17（100）
进食油腻食物	4（23.5）
饮酒	3（21.4）

项目	例数（%）
血清学检查
肿瘤标志物（CA199、CA125、CEA、 CA242、CA724）任意一项升高	13（76.5）
血淀粉酶升高	10（58.8）
空腹血糖升高	9（52.9）
肝酶（ALT、AST、γ-GT、AKP）任意一项升高	6（35.3）
总胆红素升高	4（23.5）
影像学检查
胰头占位	11（64.7）
胰体尾占位	6（35.3）
胰管扩张	15（88.2）
胆管扩张	8（47.1）
胰管截断	5（29.4）
阻塞性胰腺炎^a)	5（29.4）
胰源性门静脉高压	2（11.8）
胰尾部萎缩	2（11.8）
血管侵犯（包括腹腔干、肠系膜上下血管、腹腔动脉主干等）	7（41.2）
腹水	3（17.6）

治疗	例数（%）	病理	例数（%）
保守治疗（化疗为主）	3（17.6）	类型
放弃手术治疗	1（5.9）	导管腺癌	11（64.7）
手术治疗	13（76.5）	TNM分期
胰十二指肠切除术^a)	5（29.4）	Ⅰ	6（35.3）
胰体尾切除术	4（23.5）	Ⅱ	3（17.6）
全胰切除术	2（11.8）	Ⅲ	4（23.5）
肝转移灶切除术	1（5.9）	Ⅳ	4（23.5）
胆囊切除术+ 肝结节组织活检	1（5.9）
术后化疗	8/13（61.5）

References23

[1]	Siegel RL, Miller KD, Jemal A. Cancer statistics,2018[J]. CA Cancer J Clin, 2018, 68(1):7-30. doi:10.3322/caac.21442 URL
[2]	Kamisawa T, Wood LD, Itoi T, et al. Pancreatic cancer[J]. Lancet, 2016, 388(10039):73-85. doi:10.1016/S0140-6736(16)00141-0pmid:26830752
[3]	Mujica VR, Barkin JS, Go VL. Acute pancreatitis secon-dary to pancreatic carcinoma. Study Group Participants[J]. Pancreas, 2000, 21(4):329-332. doi:10.1097/00006676-200011000-00001 URL
[4]	王春友, 李非, 赵玉沛, 等. 急性胰腺炎诊治指南(2014)[J]. 临床外科杂志, 2015, 23(1):1-4.
[5]	虞先濬, 刘亮, 徐华祥, 等. 胰腺癌综合诊治指南(2018 版)[J]. 临床肝胆病杂志, 2018, 34(10):2109-2120.
[6]	Munigala S, Kanwal F, Xian H, et al. Increased risk of pancreatic adenocarcinoma after acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2014, 12(7):1143-1150.e1. doi:10.1016/j.cgh.2013.12.033 URL
[7]	Imamura M, Asahi S, Yamauchi H, et al. Minute pancrea-tic carcinoma with initial symptom of acute pancreatitis[J]. J Hepatobiliary Pancreat Surg, 2002, 9(5):632-636. doi:10.1007/s005340200086 URL
[8]	张慧敏, 金梦, 钱家鸣, 等. 胰腺癌合并急性胰腺炎和单纯急性胰腺炎诊断分析[J]. 中国实用内科杂志, 2017, 37(2):145-147.
[9]	田雨霖, 郭克建. 慢性胰腺炎与胰腺癌[J]. 中国实用外科杂志, 1997, 17(4):16-17.
[10]	Sakorafas GH, Tsiotou AG. Etiology and pathogenesis of acute pancreatitis: current concepts[J]. J Clin Gastroenterol, 2000, 30(4):343-356. pmid:10875461
[11]	Ballehaninna UK, Chamberlain RS. The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal[J]. J Gastrointest Oncol, 2012, 3(2):105-119. doi:10.3978/j.issn.2078-6891.2011.021pmid:22811878
[12]	傅德良, 倪泉兴, 虞先濬, 等. 血清肿瘤标记物联合检测在胰腺癌诊治中的作用[J]. 外科理论与实践, 2001, 6(2):82-84.
[13]	Bracci PM, Wang F, Hassan MM, et al. Pancreatitis and pancreatic cancer in two large pooled case-control studies[J]. Cancer Causes Control, 2009, 20(9):1723-1731. doi:10.1007/s10552-009-9424-x URL
[14]	Carriere C, Young AL, Gunn JR, et al. Acute pancreatitis markedly accelerates pancreatic cancer progression in mice expressing oncogenic Kras[J]. Biochem Biophys Res Commun, 2009, 382(3):561-565. doi:10.1016/j.bbrc.2009.03.068 URL
[15]	Conrad C, Fernandez-del Castillo C. Preoperative evaluation and management of the pancreatic head mass[J]. J Surg Oncol, 2013, 107(1):23-32. doi:10.1002/jso.23165 URL
[16]	李明欣, 尚东, 徐贺, 等. 首发症状为急慢性胰腺炎的胰腺癌诊断与治疗[J]. 中华消化外科杂志, 2014, 13(11):859-863.
[17]	Fan Z, Li Y, Yan K, et al. Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions--a comparison of conventional ultrasound and contrast-enhanced CT[J]. Eur J Radiol, 2013, 82(9):1385-1390. doi:10.1016/j.ejrad.2013.04.016 URL
[18]	崔云涛. 胰腺癌的早期CT与MRI诊断[J]. 影像研究与医学应用, 2017, 1(17):117-118.
[19]	李亮, 程三房, 乔万海. 胰腺癌的多层螺旋CT及MRI影像学诊断分析[J]. 中国CT和MRI杂志, 2016, 14(8):4-6.
[20]	Wang Z, Chen JQ, Liu JL, et al. FDG-PET in diagnosis, staging and prognosis of pancreatic carcinoma: a meta-analysis[J]. World J Gastroenterol, 2013, 19(29):4808-4817. doi:10.3748/wjg.v19.i29.4808 URL
[21]	Grino P, Martinez J, Grino E, et al. Acute pancreatitis secondary to pancreatic neuroendocrine tumours[J]. JOP, 2003, 4(2):104-110.
[22]	Kimura Y, Kikuyama M, Kodama Y. Acute pancreatitis as a possible indicator of pancreatic cancer: the importance of mass detection[J]. Intern Med, 2015, 54(17):2109-2114. doi:10.2169/internalmedicine.54.4068 URL
[23]	Pelletier AL, Hammel P, Rebours V, et al. Acute pancreatitis in patients operated on for intraductal papillary mucinous neoplasms of the pancreas: frequency, severity, and clinicopathologic correlations[J]. Pancreas, 2010, 39(5):658-661. doi:10.1097/MPA.0b013e3181c81b74 URL