Pancreatographic abnormalities due to pancreatic cancer

Share Embed

Descrição do Produto


Pancreatographic abnormalities due to pancreatic cancer

R. A. Norton, K. Ogoshi, Y. Hara, M. Niwa, R. E. Paul, Jr., J. Tomas, K. Fawaz,

M.D. M.D. M.D. M.D. M.D. M.D. M.D.

Boston, Massachusetts

The endoscopic cannulation records of two medical centers (Niigata, Japan and NEMCH, Boston, Mass.) were studied for evidence of pancreatic cancer. Of a total group of 483 pancreatic ductograms, 33 were characteristically abnormal and fell into 4 patterns: stenotic, tapering, obstructed, or unclassified. Three causes of false-positive patterns emerged: idiopathic chronic pancreatitis, surgical mobilization of the head of the pancreas, and traumatic pancreatitis. No false-negative results have been found in this brief followup period. The endoscopic method remains valid for preoperative diagnosis of pancreatic cancer, keeping in mind these sources of false-positive results. Endoscopic pancreatography has shown great promise for nonoperative diagnosis. Following the pioneering efforts of Hirschowitz ' and of McCune2 in this country and of TakagP and of Oi 4 in japan, the techniques of retrograde pancreatography have been developed and refined. They are now in use at medical centers around the world. Radiographic patterns consistent with pancreatic carcinoma have been reported by Kasugai 5 in Nagoya, japan, and by Ogoshi 6 in Niigata, japan, and a classification of these patterns was proposed by Ogoshi. Because of the intense interest in this subject by gastroenterologists and radiologists, we have studied the records of patients undergoing cannulation at our 2 medical centers, Niigata, japan, and the New England Medical Center in Boston. PATIENTS AND METHODS Cannulation efforts began in Niigata, japan, in january 1970 and in Boston in November 1971. Patients with suspected pancreatic or biliary disease were selected for study. Peroral endoscopic cannulation of the papilla of Vater was carried out in the manner previously described by Cotton 7 and by Ogoshi using the Olympus jFB duodenoscope and Teflon cannula. Patients whose pancreatograms showed obstruction or deformity consistent with carcinoma form the basis of this report. Further study by laparotomy, necropsy or clinical observation confirmed or excluded carcinoma in these patients. RESULTS In the combined experience of both medical centers, we have had 483 successful cannulations. In this group there have been 33 patients with pancreatic carcinoma and 3 patients with duct obstruction due to non-tumor causes. Following the classification of Ogoshi and his co-workers in the Japanese/ournal of Clinical Radiology, july 1972, the cancer cases were divided into 3 types. A fourth group of unclassified patterns is added. The pancreatographic patterns in our series were stenotic in 12, tapering in 5, obstructed in 15, and unclassified in 1. Figure 1 illustrates the pattern of each type. The symptoms which led to cannulation study in the group of 25 patients accessible for review were jaundice in 8, pain in 17, mass in 3, diarrhea in 2, and thrombophlebitis in 1. Some patients had more than one symptom. The outcome

of surgery is described in Figure 2. At the present time, 19 patients have succumbed and 4 are living. CASE REPORTS Type 1 is represented by a 68-year-old man who noted jaundice 2 months before admission to the Niigata Cancer Center Hospital. Laboratory studies confirmed an obstructive type of jaundice, and cannulation showed stenosis with dilatation of the pancreatic duct above the narrowed area. Because of the patient's condition, surgery could not be carried out, and the patient expired 2 months later. At necropsy pancreatic carcinoma, widely spread, was confirmed. Further study of the main pancreatic duct at autopsy showed that there was now complete obstruction of the main pancreatic duct.







Figure 1: Abnormal pancreatic duct patterns in carcinoma of the pancreas.

From the New England Medical Center Hospital, Boston, Massachusetts, and The Niigata Cancer Center Hospital, Niigata, Japan. Reprint requests: Dr. R. A. Norton, The New England Medical Center Hospital, Boston, Mass. 02100. VOLUME 20, NO, 1, 1973

Niigata, Japan



~ 16 Laparotomy

9 No Laparotomy



revealed moderate dilatation and incomplete filling of the main pancreatic duct. There were large rectangular filling defects within the duct, initially thought to represent stones. At laparotomy a papillary cystadenocarcinoma of the pancreas was discovered with intraductal tumor growth. A Whipple procedure was carried out, and all 17 lymph nodes in

Lihat lebih banyak...


Copyright © 2017 DADOSPDF Inc.