The increasing problem of unusual pancreatic tumors

Hypothesis: Patients presenting with a pancreatic mass often have a curable lesion rather than the more common adenocarcinoma. Greater awareness of th is among nonsurgeons is necessary. Design: Retrospective case series. Setting: Tertiary care referral hospital. Patients: All patients who presented with a pancreatic mass during the 8 ye ars from 1990 to 1998 were studied. Patients with a history of chronic panc reatitis, a functioning pancreatic neuroendocrine tumor, or pancreatic aden ocarcinoma were excluded. Forty patients were identified, demographic and c linical characteristics recorded, and long-term follow-up obtained. Interventions: Therapy included either a Whipple procedure or distal pancre atectomy. Two patients underwent a biliary bypass. Main Outcome Measures: Tumor histology, morbidity, and survival. Results: Three hundred thirty-six patients with a pancreatic mass were trea ted during this 8-year period. Two hundred ninety-six of these had pancreat ic adenocarcinoma. Forty (11.9%) of the 336 patients had other types of pan creatic tumors. Two thirds of these patients were female, with an average a ge of 57 years. Seventy-five percent of these tumors were either malignant or potentially malignant. In several instances, cystic turners were diagnos ed as inflammatory pseudocysts and managed accordingly. Fourteen (35%) of 4 0 patients had no symptoms and their tumor was found on a computed tomograp hic scan performed for another indication. Percutaneous biopsy was performe d in 9 patients, of whom 5 were assigned all incorrect diagnosis. There wer e no operative deaths, although the postoperative complication rate was 23% . Conclusions: In this series, nearly 12% of patients presenting with a pancr eatic mass did not have pancreatic adenocarcinoma, but rather more favorabl e lesions amenable to operation. Preoperative biopsy should not be carried out. Curative procedures can be safely performed in centers seeing a large number of patients with pancreatic turners, and the long-term results of ex tirpation are excellent.