Differential diagnosis of focal pancreatitis and pancreatic cancer

The differentiation of focal, chronic pancreatitis (CP) and pancreatic canc er (PAC) poses a diagnostic dilemma. Both conditions may present with the s ame symptoms and signs. The complexity of differential diagnosis is enhance d because PAC is frequently associated with secondary inflammatory changes and CP may develop into PAC. The aim of this study was tot analyze two sets of patients (group A and B) who were misdisagnosed to have either CP or PA C. The clinical and radiographical features of these patients were reviewed . Group A consisted of 22 patients (median age 54.5 years) who were referre d with PAC after a previous diagnosis of PC. Eleven patients had a history of CP of >12 mths (mean 40.2 mths) whereas in Ii patients, PAC became appar ent within 12 mths (mean 4.9 mths) after the diagnosis of CP was made. The etiology of CP was alcohol abuse in 9 patients, pancreas divisum in 3 patie nts and was undefined in the remaining 10 patients. Imaging studies showed features of CP (parenchymal calcifications, irregularities and stenoses of the pancreatic duct wall). Pseudocysts were present in 13 patients. A mass lesion was detected in 13 patients. At the time of diagnosis, 20 patients h ad unresectable tumors and 2 patients underwent a Whipple resection which p roved non-radical. Group B consisted of 14 patients (median age 53 years) w ho underwent a Whipple resection for a presumed PAC that on histopathology of the lesion proved to be CP. These patients accounted for 6% of all 220 p atients who had undergone resection for PAC in the same period. Reassessmen t of clinical presentation and all imaging studies confirmed a high index o f suspicion on PAC in these patients. Conclusion: Ln patients known with CP , misdiagnosis of PAC is a potential pitfall leading to delay of treatment. For any lesion suspicious of PAC an aggressive surgical approach is justif ied lest a potentially curable lesion is missed. As a consequence, there is at least a 5% chance of resecting a lesion based on CP, mimicking PAC.