Pancreatic Incidentaloma New approach to the pancreatic neoplasm by health screening

Kim, Dae Kyum; Heo, Jin Seok; Noh, Jae Hyung; Sohn, Tae Sung; Choi, Seong Ho; Kim, Yong Il; Choi, Yoon Ho

Abstract

PURPOSE: Recently, the importance of early diagnosis and early treatment has been increasing, and there are many cases where tumors have been discovered incidentally. However, due to lack of reports regarding pancreatic cases, the clear management plan remains in dispute. This study attempted to analyse pancreatic cases so as to offer a management direction. METHODS: From October 1994 to May 1999, we experienced 28 cases of incidentally discovered pancreatic tumors and those cases were reviewed retrospectively. RESULTS: In regards to initial referrals for diagnosis, 19 cases were from general medical examinations, and 9 cases were referred due to symptoms or signs not related to their tumors (2 cases with hepatitis B, 2 cases with lung lesions, 1 case with a gastric leiomyosarcoma, 1 case with vaginal bleeding, 1 case with acute enteritis, 1 case with a toothache and 1 case with a headache). Twenty cases were initially detected from abdominal US, 3 cases from abdominal CT, 2 case from chest CT, 2 case from the simple abdomen, and 1 case from CA 19-9 investigation. The accuracies for diagnosing the precise type of tumor were CT 42.3% (11/26), ERCP 15.3% (2/13), abdominal US 12.5%, and (3/24). Postoperative pathologies included 7 serous cystadenomas, 6 solid-pseudopapillary tumors, 4 mucinous cystic neoplasms, 4 nonfunctioning islet cell tumors, 2 intraductal papillary mucinous neoplasms, 2 simple cysts, 1 ductal adenocarcinoma, 1 benign retension cyst, and 1 pseudocyst. Among these were 5 malignant neoplasms (3 nonfunctional islet cell tumors, 1 ductal adenocarcinoma, and 1 mucinous cystic neoplasm), and 17 cases (60.7%) were premalignant tumors. All cases were treated with a pancreatic resection, and postoperative follow-up was carried out for a period of 3-66 months. During thisperiod, no recurrence or mortality was noted other than 1 case of liver metastasis 12 months postoperatively for ductal adenocarcinoma.
CONCLUSION
Although presence of a ductal adenocarcinoma is rare in incidentally discovered pancreatic tumors pancreatic incidentaloma is common in premalignant neoplasms. Therefore, even in asymptomatic cases, aggressive surgical resection is necessary for accurate diagnosis and early treatment.