만성췌장염과 가성낭종 형태로 발생한 췌장암
Pancreatic Carcinoma Presenting as Chronic Pancreatitis with Pseudocyst
정오, 장혁재, 조용필, 김용호, 한명식, 김송철, 한덕종,
소속 상세정보
정오 ( Cheong Oh )
울산대학교 의과대학 서울아산병원 외과학교실
장혁재 ( Jang Hyuk-Jai )
울산대학교 의과대학 강릉아산병원 외과학교실
조용필 ( Cho Yong-Pil )
울산대학교 의과대학 강릉아산병원 외과학교실
김용호 ( Kim Yong-Ho )
울산대학교 의과대학 강릉아산병원 외과학교실
한명식 ( Han Myoung-Sik )
울산대학교 의과대학 강릉아산병원 외과학교실
김송철 ( Kim Song-Chael )
울산대학교 의과대학 서울아산병원 외과학교실
한덕종 ( Han Duck-Jong )
울산대학교 의과대학 서울아산병원 외과학교실
KMID : 0371320040660060514
Abstract
A pseudocyst, one of the most prominent and definitive signs of pancreatitis, can also be cause by pancreatic carcinoma. However, a pancreas carcinoma and pancreatitis are sometimes indistinguishable. Reports of a pancreatic carcinoma coexisting with pancreatitis and a pseudocyst are rare. We have experienced a case of a pancreatic carcinoma, which was misdiagnosed as chronic pancreatitis with a pseudocyst. A 31-year-old man complaining of an epigastric pain visited our hospital. Ultrasonography (US) and computed tomography (CT) revealed two cystic lesions, about 8 and 2 cm in diameter, splenic vein thrombosis and diffuse inflammatory changes in the pancreatic body and tail. The value of the tumor marker, CA19-9, was 132 U/ml. Chronic pancreatitis with pseudocyst was suspected, and a cystogastostomy and splenectomy performed. A histological examination revealed a pancreatic pseudocyst. The patient was readmitted 7 months later due to abdominal pain. The serum CA19-9 level was 544 U/ml. The CT revealed severe diffuse inflammatory changes in the pancreatic body and tail. Percutaneous CT-guided fine-needle aspiration revealed a pancreatic adenocarcinoma. The differentiation between the pseudocyst of pancreatitis and the secondary cyst caused by a pancreatic carcinoma is important but is difficult or impossible in some cases. The CT features of pseudocysts secondary to a pancreatic carcinoma are identical to those of pseudocysts in pancreatitis. Even in retrospect, our case was difficult to differentiate from pancreatitis with pseudocysts. Our results indicate that whenever pancreatic cysts are encountered in patients with unusual presentation, further examinations, including percutaneous aspiration biopsies, should be performed to exclude malignancy.
키워드
췌장암;췌장 가성낭종;Pancreatic carcinoma;Pseudocyst
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