Daum Life On Daum

							   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.