Incidentally Discovered Tumors of the Pancreas in General Medical Examination Dae Kyum Kim, Sang Ik Noh, Jin Seok Heo, Jae Hyung Noh Tae Sung Sohn, Sung Joo Kim,Seong Ho Choi, Jae Won Joh, Yong Il Kim,Yoon Ho Choi* Department of Surgery and Health Service Center*, Samsung Medical Center, Sungkyunkwan University, School of Medicine Introduction •Recently, the importance of early diagnosis is increasing and there are many cases where tumors have been discovered incidentally in general medical examination. •However due to lack of reports in regard to pancreatic cases, clear management plan remains to be in dispute. Patients and Methods •Duration : From Oct. 1994 to July. 1999 in Samsung Medical Center •Patients : 184 patients were explored due to pancreatic tumors 28 patients were incidentally discovered cases without symptom •Reviewed retrospectively in terms of clinical findings, pre-& post-operative diagnosis, and follow-up. Results 1. Age and Sex Number of patients Age (years) 20~29 1 30~39 6 40~49 7 50~59 8 60~69 6 Sex Male 10 Female 18 2. Initial Referrals for Diagnosis Number of patients General medical examination 19 Symptoms or signs unrelated 9 to their tumors Lung lesion (eg. Granuloma) 2 Follow up for hepatitis 2 Follow up for gastric leiomyosarcoma 1 Vaginal bleeding 1 Acute gastroenteritis 1 Headache 1 Toothache 1 3. Initial Detection Methods Number of patients Abdominal US 20 Abdominal CT 3 Chest CT 2 Simple abdomen 2 Serum CA 19-9 1 4. Detection Rate of the Lesions Detection rate (%) Abdominal CT 26/26 (100.0) Abdominal US 23/24 ( 95.8) ERCP 8/13 ( 61.5) 5. Diagnostic Accuracy (Compared with postoperative pathologic diagnosis) Accuracy (%) Abdominal CT 11/26 (42.3) ERCP 2/13 (15.3) Abdominal US 3/24 (12.5) 6. Kinds of incidental pancreatic tumors Number of patients Serous cystadenoma 7 Solid and papillary neoplasm* 6 Mucinous cystic neoplasm* 4 (Malignant) (1) Nonfunctioning islet cell tumor* 4 (Malignant) (3) Intraductal papillary mucinous neoplasm* 2 Simple cyst 2 Ductal adenocarcinoma* 1 Benign retension cyst 1 Pseudocyst 1 Total 28 *Malignant or premalignant tumor 17 (60.7%) 7. Locations Head Body Tail Serous cystadenoma Solid and papillary neoplasm Mucinous cystic neoplasm Nonfunctioning islet cell tumor Intraductal papillary mucinous neoplasm Simple cyst Ductal adenocarcinoma Benign retension cyst Pseudocyst 8. Operations and Operative Complications Operation Number of patients Complication (Number of patients) Distal Pancreatectomy 20 Pancreatic leakage (2) Pancreaticoduodenectomy 6 Pseudoaneurysm (1) Middle segmental pancreatectomy 1 Enucleation 1 Total 28 3 (10.7%) 9. Recurrence Duration of follow up Recurred Non-recurred 3~53 months 1* 27 (Mean : 32.1 months) * A patient with Ductal adenocarcinoma Mass Mass CT of a serous cystadenoma (Left) and a mucinous cystadenoma (Right). It were difficult to differentiate precise types of tumors. Conclusion •Although presence of ductal adenocarcinoma is rare in incidentally discovered pancreatic tumors, it is common to be the tumor of having malignant potential. •Therefore, even in asymptomatic cases, aggressive surgical resection will be necessary for accurate diagnosis and early treatment.