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Pancreatic cystic lesion (PCL) is a relatively low incidence of pancreatic disease. No clinical symptoms of PCL prevalence rate is 2.4% ~ 13.5% and has a tendency to increase with the increase of age. With the development of modern imaging technology and the improvement of people health consciousness, there has been a dramatic increase in the prevalence of PCL. PCLs involving a wide range of pathology can range from obviously benign to borderline malignant potential lesions to overt malignancy. Pancreatic cystadenocarcinoma belongs to one of the malignant tumor of PCLs, may be malignant from pancreatic cystadenoma, and it is clinically rare, accounting for only 1% of the malignant tumors of the pancreas. Preoperative diagnosis is difficult of the disease, it mostly need to postoperative pathological diagnosis. The main symptoms of pancreatic cystadenocarcinoma are dull pain or low back pain in the upper and middle abdomen, and mass in the upper abdomen. Abdominal pain is not intense, some patients only for the feeling of fullness discomfort. Other symptoms may include loss of appetite, nausea, indigestion, weight loss, jaundice, and in a few patients, gastrointestinal bleeding. In this paper, we report a rare case of pancreatic cystadenocarcinoma with a huge cystic lesion that grows rapidly in a short period of time in pregnant women, which preoperative diagnosis is considered pancreatic cystadenoma in the preoperative. Complete resection was performed and histological examination confirmed the diagnosis of pancreatic cystadenocarcinoma.

The common presenting symptoms of pancreatic cancer are abdominal pain, weight loss, and jaundice. Pancreatic adenocarcinoma presenting with diabetic ketoacidosis is a very rare emergent clinical condition. However, pancreatic ductal cystadenocarcinoma presenting with diabetic ketoacidosis was not reported. We describe a 60-year-old man with pancreatic cystadenocarcinoma presenting with diabetic ketoacidosis as the initial manifestation. It must be kept in mind that in diabetic ketoacidosis cases, the precipitating factor may be pancreatic ductal cystadenocarcinoma. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license

To retrospectively determine the accuracy of baseline ultrasound (BUS) and of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of pancreatic solid-cystic lesions.Fifty-four pancreatic solid-cystic lesions in 52 patients were examined with BUS and CEUS, two different seniority radiologists read the images independently, Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic value of BUS and CEUS in the diagnosis of benign or malignant pancreatic solid-cystic lesions, the diagnostic consistency between different seniority radiologists was evaluated by Kappa statistics.Among the 54 lesions, there were pancreatic cyst five cases, pancreatic pseudocyst twenty cases, pancreatic cystadenoma eight cases, pancreatic cystadenocarcinoma seven cases, intraductal papillary mucinous neoplasm of pancreas (IPMN) three cases, pancreatic carcinoma combined liquefied six cases, solid-pseudopallary tumor of pancreas (SPTP) three cases, pancreatic myopericytoma one case, pancreatic lymphangioma one case. After ROC analysis, the areas under the ROC curve (Az) were 0.752 by BUS, 0.928 by CEUS to resident radiologist, and 0.896 by BUS, 0.954 by CEUS to staff radiologist. The correct diagnosis rate of specific disease was 42.6% by BUS, 64.8% by CEUS to staff radiologist (P0.05), and 33.3% by BUS, 53.7% by CEUS to resident radiologist (P0.05). The interobserver agreement in CEUS is higher than that in BUS, the Kappa value was 0.889 ± 0.062 and 0.428 ± 0.126 respectively.Compared with BUS, CEUS can significantly enhance the diagnostic rate of pancreatic solid-cystic lesions.

Objective To study the epidemiological features of pancreatic cystadenoma and cystadenocarcinoma in China during the last 10 years and to analyze the diagnosis and treatment. Methods Reports on pancreatic cystadenoma and cystadenocarcinoma published from 2000 to 2009 were retrieved from various databases, such as WANFANG data, VIP web and China National Knowledge Infrastructure (CNKI). The epidemiological features of pancreatic cystadenoma and cystadenocarcinoma and its diagnosis and treatment were analyzed. Results Totally 1 865 patients with pancreatic cystadenoma and cystadenocarcinoma were reported in China during the last 10 years. The male to female ratio was approximately 1:2.1. The accurate ages were reported in 1 536 cases, the average age of them was 50.8 years, whose average age from 40 to 60 years old accounted 75.9% of the patients. 65.3% of the cases were located in East China and Central China. Abdominal pain was the main clinical manifestation and was found in 54.9% of the patients. Pancreatoduodenectomy and resection of body and tail of the pancreas were the main procedure for the treatment of pancreatic cystadenoma and cystadenocarcinoma. Conclusion Pancreatic cystadenoma and cystadenocarcinoma were mainly found in older women in East and Central China. Preoperative diagnosis is difficult. Pancreatoduodenectomy and resection of pancreatic body and tail were the main procedure for the treatment of pancreatic cystadenoma and cystadenocarcinoma.

Background We describe our experience with laparoscopic pancreaticoduodenectomy, including 5-year actuarial survival rates. Study Design This is a retrospective study of selected patients who underwent laparoscopic pancreaticoduodenectomy at a single center between 1998 and 2006. We have described the salient features of our technique and followup protocol. Patient characteristics, histologic variety of the tumor, resection margins, morbidity, mortality, and actuarial survival rates were studied. Results The procedure could be completed laparoscopically with tumor-free margins in all patients, including patients with ampullary carcinoma (n = 24), pancreatic cystadenocarcinoma (n = 4), pancreatic head adenocarcinoma (n = 9), low common bile duct cancer (n = 3), and two patients with chronic pancreatitis with a suspicious mass lesion in the head of pancreas. Mean age of patients was 61 years (range 28 to 70 years). There was a single perioperative mortality. Overall followup rate was 95.1%, with two patients lost to followup at 22 and 36 months. Among the survivors, two patients have metastatic disease and local recurrence developed in one patient. Five-year actuarial survival rates for all patients with malignancy, ampullary adenocarcinoma, pancreatic cystadenocarcinoma, pancreatic head adenocarcinoma, and common bile duct adenocarcinoma are 32%, 30.7%, 33.3%, 19.1%, and 50%, respectively. Presence of microscopic lymph node involvement is associated with poor survival, although operations in the setting of chronic pancreatitis resulted in increased morbidity. Conclusions Laparoscopic pancreaticoduodenectomy can be performed with safety and good results in properly selected patients. Localized malignant lesions, irrespective of histopathology, are particularly amenable to this approach.

52歳の女性で, 平成13年6月頃昼頃突然左側腹部から背部痛出現し近医を受診した. CTおよび腹部超音波検査にて膵尾部に4cm大の膵嚢胞を認め当院消化器科に紹介された. 上腹部造影CT検査で, 脾上極の梗塞とそれに連続して膵尾部から脾門部にかけて辺縁に造影効果のある嚢胞性腫瘤を認め, 膵尾部腫瘍による脾梗塞と診断し手術を施行した. 開腹所見は膵尾部から脾門部において硬い腫瘤を触知した. 脾上極は嚢胞を形成し腫瘤と一塊となっていたため, 膵尾部脾合併切除を行った. 病理検査は膵尾部の嚢胞性膵癌で, 脾動脈分枝内に腫瘍浸潤を認めた. またその末梢で脾は虚血性変化を示しており, 嚢胞性膵癌による脾梗塞と診断された. 膵疾患による脾合併症は比較的まれであり, 脾梗塞を合併する事は極めてまれである.今回我々は脾梗塞を合併した浸潤性粘液性膵嚢胞腺癌の1例を経験したので報告した.

4129 Background: Cystadenocarcinoma (CAC) of the pancreas is a rare pancreatic and therefore there is limited data on the characteristics, treatment and prognosis of this disease. Methods: Patients who underwent resection for CAC (n = 1,205) between 2003 and 2012 were identified from National Cancer Data Base. The clinicopathological characteristics and treatment outcomes were compared to patients with resected ductal adenocarcinoma (DAC) (n = 15,696). Cox-proportional hazard model was used to adjust for potential prognostic factors. A nomogram was constructed and validated to predict the outcomes of patients with CAC by using multiple variable Cox-proportional model and receiver operating characteristics curve methods. Results: Compared with resected DAC, patients with resected CAC are diagnosed at a younger age (58.7 vs. 61.2, p < 0.0001); female predominant (63.7% vs. 48.8%, p < 0.0001); more often Black (15.0% vs. 9.3%, p < 0.0001);had larger tumor (0-2, 2-4 and > 4cm:17.5%, 24.3%, 53.5% vs. 16.8%, 48.3% , 32.1%, respectively, p < 0.0001); have less total number of examined lymph nodes (10.6 vs. 14.5, p < 0.0001) and fewer positive lymph nodes(0.6 vs. 2.3, respectively). CAC patients were less likely to receive chemotherapy (28.8% vs. 62.5%, p < 0.0001) and radiation therapy (16.4% vs. 36.9%, p < 0.0001). CAC patients had significantly better overall survival than those with DAC (5 year survival: 55.6% vs. 17.3%, p < 0.0001). The survival advantage was primarily seen in patients with early stage disease (5 year survival: 70.9% vs. 36.9% in stage I patients, p < 0.0001, and 32.7% vs. 14.5% in stage II patients, p < 0.0001 respectively) and persisted after adjusting the known prognostic factors including age, AJCC staging, Charlson-Deyo score, type of surgery, chemotherapy, tumor size, and lymph node ratio (adjusted hazard ratio: 0.43, 95% confidence interval: 0.39-0.48, p < 0.0001). Conclusions: Patients with CAC had significantly better survival than those with pancreatic DAC even after controlling for known prognostic factors. The proposed nomogram could accurately predict patients’ outcome and may be used as a tool for clinical decision making.

Polycystic kidney disease is an autosomal dominant disease that may be associated with cystic disease of the liver. In women, the cysts may develop early and be more troublesome than in men. Cystadenocarcinoma of the pancreas is uncommon, comprising 1% of primary pancreatic malignancies. This case report is the first to describe a familial association between polycystic kidney disease and cystadenocarcinoma of the pancreas and liver in the English medical literature. A patient with autosomal dominant polycystic kidney disease (ADPKD) and multiple hepatic cysts developed cystadenocarcinoma of the pancreas with multiple malignant liver cysts. The patient's mother, sister, and niece had ADPKD, and the patient's sister also died of pancreatic cystadenocarcinoma. We believe that the development of these two disease entities in which the primary pathology is cyst formation has a genetic association.

Despite a paucity of data, cystadenocarcinoma of the pancreas has been considered to be resistant to chemoradiation, with a limited effect similar to that of the more common pancreatic adenocarcinoma. We describe a case of a partially excised cystadenocarcinoma with a positive surgical margin that was treated by neoadjuvant chemoradiation. No epithelial elements were found on histologic examination after reresection. Three previous cases of dramatic response of pancreatic cystadenocarcinoma to chemoradiation have been described in the literature. The current dogma alleging poor response of pancreatic cystadenocarcinoma to chemoradiation may be in error.

We describe a case of clinical benefit and partial response with Gemcitabine and Oxaliplatin (GEMOX) in a young patient with ovarian metastasis from cystadenocarcinoma of the pancreas. A young woman complained of abdominal pain and constipation. Computed tomography (CT) and magnetic resonance imaging (MRI) scans disclosed two bilateral ovarian masses with pancreatic extension. She underwent bilateral ovarian and womb resection. During surgery peritoneal carcinosis, a pancreatic mass and multiple abdominal lesions were found. The final diagnosis was mucinous pancreatic cystadenocarcinoma with ovarian and peritoneal metastases. She started chemotherapy with Gemcitabine 1000 mg/m2/d1 and Oxaliplatin 100 mg/m2/d2 every two weeks (GEMOX). After twelve cycles of chemotherapy a CT scan showed a reduction of the pancreatic mass. She underwent distal pancreatic resection, regional lymphadenectomy and splenectomy. Pathologic examination documented a prominent fibrous tissue and few neoplastic cells with mucin-filled cytoplasm. Chemotherapy was continued with Gemcitabine as “adjuvant treatment” for another three cycles. There is currently no evidence of disease. As reported in literature, GEMOX is associated with an improvement in progression-free survival and clinical benefit in patients with advanced pancreatic cancer. This is an interesting case in which GEMOX transformed inoperable pancreatic cancer into a resectable tumour.

The prognosis of pancreatic cystadenocarcinoma is known to be relatively favorable, unlike poor prognosis of the majority of pancreatic cancers. However, little is known about the pathogenesis and mode of progression of this cancer. We report on a newly established pancreatic cystadenocarcinoma cell line, OCUP-1. Its characteristics were compared to those of cells derived from pancreatic ductal cell carcinoma. OCUP-1 was established by successive culture of cancer cells obtained during an operation for pancreatic cystadenocarcinoma. This cell line demonstrated mono-layered proliferation and a doubling time of 80.3 h, which was 2.1 to 5.3 times longer than that of six ductal cell carcinoma-derived cell lines. Cell cycle time agreed with the doubling time. Tumors could be produced in all nude mice by inoculating cells from the 6 different ductal cell carcinoma derived cell lines without pre-treatment. However, with OCUP-1 cell line inoculation, the nude mice had to be pre-treated with asialo-GM1 - an inhibitor of natural killer cell activity - for tumors to be produced. Although the newly established OCUP-1 cell line demonstrated low proliferative activity, its genetic characteristics (point mutation at codon 12) were similar to those of other cells derived from ductal cell carcinomas. The OCUP-1 cell line may be used to investigate the pathogenesis and progression of pancreatic cystadenocarcinomas.

Background The c-Ki-ras oncogene (also known as KRAS2) is activated by point mutations involving codon 12 in 72%-100% of primary pancreatic adenocarcinomas, but the gene is not activated in nonneoplastic tissues. Therefore, the detection of c-Ki-ras mutations can facilitate the diagnosis of pancreatic adenocarcinomas, which are not always identified with current tests. Detection is usually performed by oligonucleotide hybridization combined with polymerase chain reaction (PCR), RNAse mismatch cleavage assay, or non-isotopic mismatched PCR, methods that are not feasible for routine screening of large numbers of samples because they are time consuming and/or expensive. Purpose Our purpose was to evaluate a rapid, non-radioactive method of detection of a mutation in codon 12 of the c-Ki-ras gene in pancreatic tumor samples obtained by fine-needle aspiration for diagnostic screening. Methods Twenty consecutive patients (15 with pancreatic adenocarcinoma, one with pancreatic cystadenocarcinoma, one with endocrine islet cell tumor, and three with chronic pancreatitis) were selected for this study. A sample of pancreatic tissue from each patient with a tumor or pancreatitis was obtained and evaluated by fine-needle aspiration biopsy under computerized tomography scan or ultrasound guidance using a two-needle coaxial technique. Pancreatic DNA from each of these samples was evaluated by PCR amplification and restriction fragment length polymorphism (RFLP) analysis with nucleotide substitution in PCR primers, creating BstNI restriction patterns that distinguished mutated from normal alleles. The accuracy of the PCR/RFLP assay was validated with DNA from SW480 and HT29 colonic carcinoma cell lines with known mutated and wild-type c-Ki-ras gene sequences. Sensitivity was tested with a series of titration experiments. Results PCR/RFLP analysis can detect a mutation present in 1% of cells. No amplification could be performed in four (20%) samples because of the absence of cells in the aspirated sample. In the 16 samples adequate for PCR/RFLP analysis, a c-Ki-ras gene mutation was detected in 11 (92%) of 12 adenocarcinomas. Overall, diagnosis was obtained by pathologic (cytomorphologic) examination alone in 13 samples (81%). The presence of malignant cells and/or mutated c-Ki-ras gene was detected in 12 of 12 adenocarcinomas but not in chronic pancreatitis or islet cell tumor. Conclusion Screening of pancreatic tissue samples obtained by fine-needle aspiration for c-Ki-ras mutation using PCR/RFLP analysis combined with pathologic examination could facilitate diagnosis of pancreatic tumors.

Two cases of cystadenocarcinoma (CAC) of the pancreas are reported. In the first case, mucinous CAC of the head of the pancreas was diagnosed 16 years after removal by left pancreatectomy of a benign

PubMed ID: 17446849, Pancreatic cystadenocarcinoma is an extremely rare neoplasm in pregnancy. To our knowledge, there have been 2 published cases of pancreatic mucinous cystadenocarcinoma (PMC) during pregnancy in the literature; one of which was reported to have ruptured into the abdominal cavity. We present a second case of ruptured PMC resulting in acute abdomen in 36 weeks of pregnancy. Rupture of mucinous cystic neoplasms of pancreas including PMC should be remembered in acute abdomen during pregnancy. © 2007 Lippincott Williams & Wilkins, Inc.

Cystic tumors of the pancreas are uncommon. They account for 10–15% of all pancreatic cystic masses and only 1% of pancreatic malignancies. Mucinous cystadenocarcinoma is the most frequent pancreatic cystadenocarcinoma and it is mainly seen in women, suggesting a sex hormone influence. Its presentation during pregnancy is infrequent and entails difficult diagnostic and therapeutic decisions. We report the case of a 31-year-old woman who presented a pancreatic cystadenocarcinoma 2 months after delivery. A 31-year-old woman was referred to our service because of abdominal pain and mass. She had given birth to her first child 2 months previous. Abdominal ultrasound demonstrated a poorly circumscribed cystic mass in the left upper abdominal quadrant, and the computed tomography scan showed a multilocular cystic lesion located in the body of pancreas. There was no seric alteration of specific pancreatic enzymes or tumor markers. Laparoscopic examination showed a large cystic tumor (12 × 11 × 5.5 cm) in the pancreas involving the body and the tail. It extended to the spleen and was highly vascularized, precluding a minimal invasive resection. An open body–tail pancreatectomy and splenectomy was performed. The resection margins were free of tumor, and the histological study showed a mucinous pancreatic cystadenocarcinoma with mucin-producing columnar epithelium and associated papillae patterns, reminiscent of ovarian stroma. Immunohistochemical studies were negative for hormonal receptors. The patient had no post-surgical complications and was discharged home in 4 days. Cystic tumors of the pancreas are infrequent, and cancer of the pancreas during pregnancy is extremely rare. Insidious symptoms and bodily changes due to pregnancy may mask diagnosis. Aggressive surgery is currently the only chance of cure.

A 98-year-old woman was admitted to our hospital complaining of anorexia, epigastralgia, and vomiting. An elastic hard tumor was palpable in her epigastric region. CT and US examination revealed a huge cystic lesion adjacent to the left lobe of the liver and the stomach. Her serum levels of CEA (13.6 ng/ml), CA19-9 (95 U/ml) and CA125 (99 U/ml) were high. She suffered from aspiration pneumonia on the 10th day of admission, which progressed to acute respiratory distress syndrome. On the 20th day of admission, the epigastric tumor suddenly disappeared. She passed away on the 31st day due to respiratory failure. Autopsy revealed that she had a ruptured pancreatic anaplastic mucinous cystadenocarcinoma. To the best of our knowledge, this is the oldest reported case of ruptured pancreatic cystadenocarcinoma in the world.

Objective Mutation of the K-ras oncogene is a frequent event in pancreatic ductal carcinogenesis and it is believed to occur at an early stage in the development of pancreatic cancer. However, little is known of the role of K-ras mutations in rare pancreatic epithelial neoplasms, endocrine tumours or other non-epithelial tumours of the pancreas. Furthermore, limited data are available regarding the role of K-ras mutations in the pathogenesis of ampullary tumours. Design and methods Using single-strand conformation polymorphism (SSCP) and direct sequencing of polymerase chain reaction (PCR)-amplified fragments, we analysed codons 12 and 13 for the presence of oncogenic mutations of the K-ras oncogene. Tissues were obtained from patients undergoing tumour resection for various rare pancreatic or ampullary neoplasms (number of cases in brackets): ampullary adenoma (1), neuro-endocrine tumour (3), malignant fibrous histiocytoma of the pancreas (1), pancreatic cystadenocarcinoma (1), serous cystadenoma (1), and primary and metastatic adenocarcinoma of the ampulla (5) and pancreas (3). Results K-ras gene mutations at codon 12 were detected in both pancreatic adenocarcinomas and in the metastatic lesion, whereas two ampullary cancers harboured a point mutation at codon 13: GGC→GGG and GGC

An autopsy case of an 83-year-old Japanese woman with pancreatic cancer with significantly elevated serum alpha-fetoprotein levels is reported. The pancreatic tumor was a mucinous cystadenocarcinoma with multiple metastasis to the liver. The immunohistochemistry for alpha-fetoprotein revealed positive reactivity in the cytoplasm of cancer cells in the primary and liver metastatic lesions. The current case is the first reported in which mucinous cystadenocarcinoma of the pancreas produced alpha-fetoprotein.

Objective: To assess the adequacy of pylorus-preserving pancreatoduodenectomy (PPPD) as a definitive surgical treatment for primary malignant diseases of the periampullary region. Design: Retrospective review of the clinical records of patients undergoing PPPD for malignant diseases of the periampullary region. Median and 5-year actuarial survival by type and stage of cancer were determined. Survival data from this study were compared with those of patients undergoing a conventional Whipple operation. Setting: Lahey Clinic, Burlington, Mass. Study Participants: One hundred six patients undergoing PPPD for primary malignant disease of the periampullary region between November 1979 and June 1992. Intervention: Pylorus-preserving pancreatoduodenectomy was performed with curative intent in the 106 patients. Ninety-five patients underwent proximal pancreatectomy; 11 patients, total pancreatectomy. Resection of the portal vein was performed in 10 patients. Main Outcome Measure: Long-term survival following PPPD was analyzed with respect to the type and stage of cancer. Median follow-up was 30 months (range, 6 to 156 months). Results: Five-year actuarial survival rates were 45.4% for patients with ampullary adenocarcinoma; 6.6%, with pancreatic ductal adenocarcinoma; 33.3%, with distal bile duct adenocarcinoma; 75%, with pancreatic islet cell adenocarcinoma; and 0%, with pancreatic cystadenocarcinoma. An early cancer stage was associated with more favorable survival for ampullary and distal bile duct adenocarcinomas. For pancreatic ductal adenocarcinoma only, tumors less than 2 cm were associated with better survival. Duodenal resection margins were free of disease in all patients, while peripancreatic and retroperitoneal extension of the tumor was found in 20%. Conclusion: For patients with periampullary malignant disease, long-term survival following PPPD is similar to that following a conventional Whipple operation. The potential benefits of hemigastrectomy with perigastric lymphadenectomy are frequently obviated by the presence of positive margins and lymph nodes elsewhere, ie, in the retroperitoneum. We advocate PPPD as the procedure of choice for locally resectable malignant disease of the periampullary region, provided the duodenal margin is viable and tumor free. (Arch Surg. 1994;129:405-412)

We report a 70-year-old woman with gastric varices due to splenic vein obstruction by a cystadenocarcinoma of the caudal pancreas. Most of the pancreatic cancer had already extensively progressed and was unresectable when an obstruction of the splenic vein was also discovered. Two contributing factors are thought to have enabled us to perform a curative resection in this case: (1) the gastric varices were detected by chance in a mass survey, (2) the cancer was not so advanced as to be unresectable.

We report a case of cystadenocarcinoma occurring in a pregnant woman. After child birth, a subtotal pancreatectomy was performed, without rupture of the cyst. The patient is asymptomatic, 24 months after sugery. The presentation of cystadenocarcinoma in pregnancy has been reported in another single case. The possibility of hormonal dependence is discussed.

Cystadenocarcinoma of the pancreas is generally considered to be unresponsive to chemotherapy and radiation therapy. We present two cases of laparotomy-proven unresectable cystadenocarcinoma which responded to intravenous 5-fluorouracil (1,000 mg/m2/24 hr × 5 days × 2) and 4,000 rads of radiation therapy. Both patients had objective response with marked shrinkage of the tumor as determined by clinical examination and computed tomography. At reexploration both tumors had become completely resectable with histologically clear margins and negative lymph nodes. Carcinoembryonic antigen (CEA) levels were elevated in both patients at initial presentation (86 and 71 ng/ml). The CEA levels declined to 19.9 and 66.0 ng/ml, respectively, after neo-adjuvant therapy, and both fell to normal levels after resection. Although surgical resection has been considered the only curative therapy for patients with pancreatic cystadenocarcinoma, we suggest that preoperative irradiation and chemotherapy may reduce the size of seemingly unresectable tumors. We also recommend serial CEA determinations in patients with levels initially elevated as a marker of the response to neo-adjuvant and operative therapy.

Ultrasonically guided percutaneous puncture of pancreatic cyst was performed on 4 patients with ultrasonically scanned cystic mass lesions in the left upper quadrant, and biochemical and cytological analyses of the aspirated cystic fluids were proved fairly diagnostic. In pseudocyst, the aspirated fluid revealed very high concentration of amylase, malignant cells being not recognized cytologically. In cystadenocarcinoma, the aspirated fluid revealed low concentrations of amylase and high concentrations of LDH and CEA, malignant cells being definitely recognized. This method is of great value for differential diagnosis of cystic diseases of the pancreas.

Cystadenocarcinomas are rare tumors of the pancreas. They are half as common as their benign counterpart--the cystadenoma. A review of 21 cases, including eight reported since 1963, revealed that most patients presented with upper abdominal pain and a large palpable upper abdominal mass. All patients had evidence of malignant degeneration occurring in a mucous cystadenoma. None had evidence of a serious cystadenoma. Grading revealed a predominance of low-grade tumors: 20 of the 21 lesions were grade 1 or 2. Cystadenocarcinomas were slightly more frequent in the head of the pancreas. Four patients had metastasis. Complete excision by distal or total pancreatectomy or Whipple pancreaticoduodenectomy is recommended. The five year survival after complete excision is 68%, and for patients with grade 1 lesions, and five year survival is 64%.

A long survival case of Zollinger-Ellison syndrome with multiple liver metastases was experienced. A 50-yearsold female with the cheif complaints of hypochondralgia, high fever and watery diarrhea was diagnosed to have a pancreatic cystadenocarcinoma. Detailed examination after admission revelaed a gastrinorna with multiple liver metastases. The patient was undertaken pancreatoduodenectomy and total gastrectomy. She is in good condition over two years after operation.Even in Zollinger-Ellison syndrome in advanced stage with multiple liver metastases, a long-term survival can be expected by complete resection of primary tumor and total gastrectomy.

A 60-year-old woman presented with a mass in the left upper abdominal quadrant. Noninvasive studies showed a cystic structure arising from the pancreas. Pathologic studies of the tumor revealed pancreatic cystadenocarcinoma; the fluid contained Strongyloides larvae. There was no evidence of disseminated Strongyloides or immunosuppression. Results of stool examinations were also negative for Strongyloides. Were these larvae the etiologic agent for the carcinoma? Other parasitic infestations have been associated with carcinoma. This is the first reported association between Strongyloides and cystadenocarcinoma.

Cystadenomas and cystadenocarcinomas are rare but not exceptional tumours of the pancreas. In this report six cases are added to the more than 300 cystadenomas and over 100 cystadenocarcinomas reported in the literature. We present here the case histories of four cystadenomas and two cystadenocarcinomas with complete follow-up. There is no evidence of recurrence after a maximum of 22 years in cystadenoma and 4 years in cystadenocarcinoma following resection. We have the impression that cystic lesions of the pancreas are nowadays more often detected than in former years. This might be due to abdominal investigation by computerized tomography and ultrasound on a large scale. Pathological features of proliferative cystic lesions of the pancreas permit distinction of three different tumours: serous cystadenoma, mucinous cystadenoma and cystadenocarcinoma. The serous cystadenoma is benign. The mucinous cystadenoma has to be considered as potentially malignant. The cystadenocarcinoma is malignant by definition. As benign and malignant elements can be found in the same cyst biopsy cannot exclude cystadenocarcinoma. Therefore all cystadenomas and cystadenocarcinomas should be totally excised, especially as prognosis after resection of cystadenocarcinoma is much better than after resection of adenocarcinoma of the pancreas.

Cystadenocarcinoma of the pancreas is uncommon, but should be positively identified and distinguished from other cystic lesions of the pancreas because of its good surgical prognosis in comparison with pancreatic adenocarcinoma. I report two cases of cystadenocarcinoma of the head of the pancreas, in which a previously undescribed abnormal appearance of the duodenal papilla was characteristic.

Eleven cases of pancreatic cystadenocarcinoma were studied with respect to the differential diagnosis from that of pancreatic pseudocysts, using diagnostic ultrasound as the initial investigative technique. Most of the cases presented an ultrasonic picture that correlated well with the gross pathology, but this correlation was not reliable enough to be considered characteristic in differentiating such masses from pseudocysts. The authors divide the cystadenocarcinomas of the pancreas into four echographic classes. In all but one of the classes, diagnostic ultrasound was insufficient by itself to render an accurate diagnosis. In such cases other techniques, i.e. CT, tissue biopsy, and especially angiography, were required for a reliable diagnosis.

Background The incidence of pancreatic tuberculosis is extremely rare, and it frequently misdiagnosed as pancreatic neoplasms. The nonsurgical diagnosis of this entity continues to be a challenge. Case presentation A 33 year old male with six-month history of intermittent right epigastric vague pain and weight lost had found a solitary pancreatic cystic mass and diagnosed as pancreatic cystadenocarcinoma. The chest X-ray film and physical examination revealed no abnormalities. Abdominal ultrasound (US) examination showed an irregular hypoechoic lesion of 6.6 cm × 4.4 cm in the head of pancreas, and color Doppler flow imaging did not demonstrate blood stream in the mass. The attempts to obtain pathological evidence of the lesion by US-guided percutaneous fine needle aspiration failed, an exploratory laparotomy and incisional biopsy revealed a caseous abscess of the head of pancreas without typical changes of tuberculous granuloma, but acid-fast stain was positive. Conclusions Pancreatic tuberculosis should be considered in the differential diagnosis of focal pancreatic lesions, especially for young people in developing countries.