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Acta Endoscopica

, 13:325 | Cite as

Cholangiowirsungographie itérative dans le diagnostic différentiel entre cancer du pancréas et pancréatite chronique. A propos de 2 cas

  • V. Pugliese
  • S. Saccomanno
  • H. Aste
  • G. Garlaschi
  • L. Santi
Article

Résumé

Les auteurs rapportent deux observations dans lesquelles la clinique était suggestive d'une maladie chronique du pancréas. Les données cliniques, du laboratoire et les examens morphologiques n'ont pas permis un diagnostic discriminatoire entre pancréatite chronique (CRP) et cancer (PC).

Comme on sait, les signes cliniques fonctionnels et pathologiques caractéristiques de la pancréatite chronique peuvent se développer au cours de l'histoire naturelle d'un cancer (PC). Un indice en faveur d'un diagnostic précoce de cancer pancréatique peut être obtenu par répétition des dosages d'isoamylase sérique et répétition de la cholangiopancréatographie transpapillaire (ERCP), chez des malades symptomatiques suspects. Dans les deux observations présentées, en l'absence de diagnostic histologique préopératoire, la répétition de la cholangiopancréatographie transpapillaire à 1 mois d'intervalle a contribué au diagnostic final et à l'exérèse en apparence radicale du cancer dans l'un des deux cas.

Mots-clés

Cancer du pancréas cholangiopancréatographie endoscopique transpapillaire (ERCP) diagnostic différentiel isoamylase pancréatite chronique récidivante 

Repeated ERCP studies in differentiating pancreatic cancer from chronic pancreatitis. Report of two cases

Summary

The cases are presented of 2 patients complaining of symptoms suggestive of chronic pancreatic disease. Clinical, laboratory and morphological evaluations did not allow differential diagnosis between pancreatic cancer (PC) and chronic relapsing non calcifying pancreatitis (CRP).

As known, clinical, functional and pathological findings characteristic of CRP could develop during the natural history of PC. Since that, a clue to earlier diagnosis of pancreatic cancer by means of repeated serum isoamylase estimations and of repeated ERCP studies in symptomatics can be proposed.

In the cases presented, given the absence of tissue diagnosis, repeated ERCP studies were of significant help in the therapeutic management of both patients.

Key-words

Chronic relapsing non calcifying pancreatitis differential diagnosis endoscopic retrograde cholangiopancreatography (ERCP) isoamylase pancreatic cancer 

Références

  1. 1.
    ANDRIULLI A., MASOERO G., FELDER M.—Circulating trypsin-like immunoreactivity in chronic pancreatitis.Dig. Dis. Sci., 1981,26, 532–537.PubMedCrossRefGoogle Scholar
  2. 2.
    BLACKSTONE M.O., COCKERHAM L., KIRSNER J.B., MOOSSA A.R. — Intraductal aspiration for cytodiagnosis in pancreatic malignancy.Gastrointest. Endoscopy, 1977,23, 145–147.CrossRefGoogle Scholar
  3. 3.
    BOWDEN L. — The fallibility of pancreatic biopsy.Ann. Surg., 1954,139, 403–408.PubMedCrossRefGoogle Scholar
  4. 4.
    BRAGANZA J.M., HUNT L.P., WARWICK F. — Relationship between pancreatic exocrine function and ductal morphology in chronic pancreatitis.Gastroenterology, 1982,82, 1341–1347.PubMedGoogle Scholar
  5. 5.
    CUBILLA A.L., FITZGERALD P.J. — Surgical pathology aspects of pancreas cancer.In:The pancreas, P.J. Fitzgerald and A.B. Morrison, Editors, Williams and Wilkins Co., Baltimore, 1980.Google Scholar
  6. 6.
    CUSCHIERI A., HALL A.W., CLARK J. — Value of laparoscopy in the diagnosis and management of pancreatic carcinoma.Gut., 1978,19, 672–677.PubMedCrossRefGoogle Scholar
  7. 7.
    DENCKER H. — Evaluation of operative biopsy of periampullary tumors.Acta Chir. Scand., 1972,138, 190–194.PubMedGoogle Scholar
  8. 8.
    DI MAGNO E.P., MALAGELADA J.R., TAYLOR W.F., GO V.L.W. — A prospective comparison of current diagnostic tests for pancreatic cancer.N. Engl. J. Med., 1977,297, 737–742.Google Scholar
  9. 9.
    FEDAIL S.S., SALMON P.R., HARVEY R.F., READ A.E. — Radioimmunoassay of lactoferrin in pancreatic juice as a test for pancreatic diseases.Lancet, jan 28, 1978, 181–182.CrossRefGoogle Scholar
  10. 10.
    GAMBILL E.E. — Pancreatitis associated with pancreatic carcinoma: a study of 26 cases.Mayo Clin. Proc., 1971,46, 174–177.PubMedGoogle Scholar
  11. 11.
    GOWLAND M., KALANTZIS N., WARWICK F., BRAGANZA J.M. — Relative efficiency and predictive value of ultrasonography and endoscopic pancreatography in diagnosis of pancreatic disease.Lancet, 1981,ii, 190–193.CrossRefGoogle Scholar
  12. 12.
    GUDJONSSON B., LIVSTONE E.M., SPIRO H.M. — Cancer of the pancreas. Diagnostic accuracy and survival statistics.Cancer, 1978,42, 2494–2506.PubMedCrossRefGoogle Scholar
  13. 13.
    GUICHARD A., FEROLDI J. — Les pancréatites chroniques paranéoplasiques. Contribution à l'étude des cancers du pancréas avec pancréatite.J. Med. Lyon, 1950,31, 153–158.Google Scholar
  14. 14.
    KOEHLER D.F., ECKFELDT J.H., LEVITT M.D. — Diagnostic value of routine isoamylase assay of hyperamylasemic serum.Gastroenterology, 1982,82, 887–890.PubMedGoogle Scholar
  15. 15.
    MOOSSA A.R., LEWIS M.H., BOWIE J.D. — Clinical features of diagnosis of pancreatic cancer.In:Tumors of the pancreas. The Williams and Wilkins Co., Baltimore, 1980, Moossa A.R., Editor, pp. 429 and 433.Google Scholar
  16. 16.
    MULTIGNER L., FIGARELLA C., SARLES H. — Diagnosis of chronic pancreatitis by measurement of lactoferrin in duodenal juice.Gut, 1981,22, 350–354.PubMedCrossRefGoogle Scholar
  17. 17.
    NAGAT A., HOMMAT T., TAMAI K. — A study of chronic pancreatitis by serial endoscopic pancreatography.Gastroenterology, 1981,81, 884–891.Google Scholar
  18. 18.
    NEWTON W.T. — Mortality and morbidity associated with resection of pancreaticoduodenal cancers.Ann. Surg., 1961,27, 74–78.Google Scholar
  19. 19.
    NISHIDA K., YOSHOKAWA T., KONDO M., THIELE H.G. — Immunological diagnosis of pancreatic cancer by assaying the carcinoembryonic antigen (CEA) in pure pancreatic juice.Hepato-gastroenterology, 1980,27, 488–494.PubMedGoogle Scholar
  20. 20.
    RALLS P.W., HALLS J., RENNER I., TUTTNER H. — Endoscopic retrograde cholangiopancreatography (ERCP) in pancreatic disease: a reassessement of the specificity of ductal abnormalities in differentiating benign from malignant disease.Radiology, 1980,134 (2), 347–352.PubMedGoogle Scholar
  21. 21.
    TAKAGI K. et al. — Small carcinoma of the head of the pancreas discovered by the clue of transitory elevation of urinary amylase level.Stomach and intestine, 1980,15, 637–640.Google Scholar
  22. 22.
    YEU-TSU N., LEE Margaret — Tissue diagnosis for carcinoma of the pancreas and periampullary structures.Cancer, 1982,49, 1035–1039.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1983

Authors and Affiliations

  • V. Pugliese
    • 1
    • 2
  • S. Saccomanno
    • 1
    • 2
  • H. Aste
    • 1
    • 2
  • G. Garlaschi
    • 1
    • 2
  • L. Santi
    • 1
    • 2
  1. 1.The Gastrointestinal Unit, Istituto Nazionale per la Ricerca sul cancroUniversity of GenoaGenova(Italy)
  2. 2.Institute of OncologyUniversity of GenoaGenova(Italy)

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