ABSTRACT: Mass-forming pancreatitis can be divided into two distinct types: alcoholic and autoimmune. There have been some cases of an ambiguous diagnosis although care was taken to differentiate between alcoholic mass-forming pancreatitis, focal type autoimmune pancreatitis and pancreatic cancer.
We report a case of pancreatic cancer mimicking alcoholic or autoimmune pancreatitis with the formation of a mass in a 32-year-old man with a history of heavy drinking. Although both serum immunoglobulin G and immunoglobulin G4 levels were normal, many serum auto-antibodies, including the antinuclear antibody, were detected. After he stopped drinking, abdominal computed tomography showed a pancreatic head mass 28 mm in diameter with little and weak enhancement in the early and delayed phases, respectively. Endoscopic retrograde cholangiopancreatography showed an obstruction of the main pancreatic duct in the pancreatic head and marked stenosis of the lower common bile duct. Although a percutaneous ultrasound-guided pancreatic biopsy demonstrated no evidence of autoimmune pancreatitis, he was treated with prednisolone to test the efficacy of steroid therapy. However, the pancreatic mass became enlarged after steroid therapy, and he underwent surgery during which the mass was found to be pancreatic cancer. Although the patient was treated with gemcitabine, he died 5 months after surgery. We retrospectively assessed DNA hypermethylation in the patient's pure pancreatic juice obtained on admission. We observed hypermethylation of the cancer-specific gene tissue factor pathway inhibitor 2 (TFPI2).
This finding suggests that if the DNA hypermethylation of pure pancreatic juice had been assayed before steroid therapy, it would have supported the diagnosis of pancreatic cancer, and steroid therapy could have been avoided.
JOP: Journal of the pancreas 02/2008; 9(1):37-45.
ABSTRACT: This study was undertaken to elucidate the diagnostic significance of the measurement of a cancer-associated carbohydrate antigen, NCC-ST-439 (ST-439), in pure pancreatic juice collected by endoscopic cannulation, chiefly from patients with pancreatic diseases.The mean concentrations of ST-439 in each of the 4 fractions collected were significantly higher in patients with pancreatic cancer than in controls, but patients with chronic pancreatitis or cholecystolithiasis did not have higher levels. Similarly, a significant increase in the mean output of ST-439 was observed only in patients with pancreatic cancer. When the cut-of value was set at the mean concentration+ 2 X the standard deviations of the controls, significant concentrations of ST-439 were found, in the first fraction (washout phase) in 56% of the pancreatic cancer cases, 31% of the chronic pancreatitis cases and 0% of the cholecystolithiasis cases; in the third fraction (secretory phase) results were 50%, 7% and 0%, respectively. Furthermore, when the cut-of value was set at the highest concentration found among patients with chronic pancreatitis (to enhance the specificity for pancreatic cancer), the prevalence of significant ST-339 levels among Pancreatic cancer patients was 50% in the first fraction and 44% in the third fraction.These results indicate that the measurement of ST-439 in pancreatic juice is useful as a specific marker for pancreatic cancer, although its sensitivity is less than was initially hoped,
Digestive Endoscopy 08/2007; 2(2):141 - 147. · 1.19 Impact Factor
ABSTRACT: The diagnostic significance of measuring sialylated stage-specific embryonic antigen-1 (SLX) in pure pancreatic juice was
evaluated in 20 patients with pancreatic cancer, 43 with chronic pancreatitis, 13 with cholecystolithiasis, and 15 control
individuals. Four fractions of pure pancreatic juice were collected sequentially from the pancreatic duct by endoscopic cannulation.
The SLX levels in all four fractions of pure pancreatic juice were significantly higher in patients with pancreatic cancer
than in controls. On the other hand, patients with chronic pancreatitis or cholecystolithiasis did not have SLX levels that
significantly differed from those of controls in any fraction. When the cut-off value was set as the mean concentration +
2 times the standard deviation of the control values, the positive rates of SLX in the first fraction (washout phase) and
the third fraction (secretory phase) of pure pancreatic juice from pancreatic cancer were 55% (11/20) and 40% (8/20), respectively.
Although the false positive rates in the first fraction were high in chronic pancreatitis (30%) and cholecystolithiasis (31%),
such high SLX levels in the third fraction were found only in one (2%) patient with chronic pancreatitis and in one (8%) with
cholecystolithiasis. The specificities of the test for pancreatic cancer in the first fraction and the third fraction were
70% (39/56) and 96% (54/56), respectively. These results indicate that the measurement of SLX in the third fraction of pure
pancreatic juice is useful as a specific marker for pancreatic cancer.
International Journal of Gastrointestinal Cancer 04/1994; 15(1):35-41.
ABSTRACT: Pancreatic cancer is detected on the basis of morphological changes delineated by means of various image-diagnostic methods. However, differentiation between chronic pancreatitis and pancreatic cancer, especially at the early stage, is not always simple when based upon the morphological changes alone. Therefore, we attempted to elucidate K-ras mutations in the sediment of pure pancreatic juice (PPJ) containing exfoliated ductal pancreatic cancer cells. PPJ was collected endoscopically from 20 patients with pancreatic cancer (PC) and 18 patients with chronic pancreatitis (CP). Polymerase chain reaction and allele specific oligonucleotide dot blot hybridization for K-ras mutations were performed with the DNA extracted from these samples. A K-ras mutation at codon 12 was identified in the PPJ of 11/20 (55%) of the patients with PC. On the other hand, the same mutation was not identified in the PPJ of any patient with CP. Moreover, K-ras mutations at codons 13 and 61 were not recognized in the PPJ of any patient with either PC or CP. These findings suggested that the presence of a K-ras mutation at codon 12 in PPJ would be useful in confirming the diagnosis of PC.
Cancer Science 08/1993; 84(9):961 - 965. · 3.33 Impact Factor
ABSTRACT: This study evaluated the diagnostic significance of concentrations of the cancer-associated carbohydrate antigen CA 19-9 in pure pancreatic juice (PPJ) collected by endoscopic cannulation. We also attempted to elucidate the features and source of the increased CA 19-9 concentration found in the pancreatic juice of patients with chronic pancreatitis (CP) by means of immunohistochemical staining. The mean output as well as the mean concentration of CA 19-9 in each of the four fractions collected was highest in patients with pancreatic cancer (PC) and also was elevated significantly in patients with CP compared with controls. However, CA 19-9 concentrations were not elevated in patients with cholecystolithiasis. When the cutoff value was set as the mean concentration + 2SD of the controls, significantly elevated concentrations of CA 19-9 were found in the third fraction (secretory phase) in 90% of the patients with PC and 66% of the patients with CP. Immunohistochemical staining revealed that CA 19-9 was expressed more widely in the ductal cells of CP tissues than in those of normal pancreatic (NP) tissues, with CP tissue showing more CA 19-9-positive ductal cells per area than NP tissues. In NP tissue, CA 19-9 was localized to the apical surface and supranuclear regions (apical type) in all the ductal cells stained by the antigen, while ~50% of cases with CP exhibited a cytoplasmic pattern showing a loss of polarity of the antigen expression. Moreover, this cellular localization pattern was more pronounced in the small ducts that had proliferated and aggregated following the destruction of lobules in CP. These results indicate that although increased concentrations of CA 19-9 in PPJ have no cancer specificity, measurement of CA 19-9 in PPJ can be used as a sensitive marker for some pancreatic disorders, and higher CA 19-9 concentrations in the pancreatic juice of patients with CP may reflect the strong expression of CA 19-9 in the proliferating small ducts associated with CP.
(C) Lippincott-Raven Publishers.
Pancreas 02/1993; 8(2). · 2.39 Impact Factor
ABSTRACT: A 63-year-old male patient with compensated cirrhosis underwent transcatheter arterial embolization (TAE) and percutaneous ethanol injection therapy (PEIT) for a minute hepatocellular carcinoma (HCC). Although the HCC was successfully treated, esophageal varices worsened and refractory ascites developed 3 months after the TAE and PEIT. Liver atrophy progressed rapidly compared to the natural course of liver cirrhosis.
Abdominal Imaging 11/1991; 16(1):164-166. · 1.73 Impact Factor
ABSTRACT: In order to elucidate the factors affecting the serum levels of CA 19-9, we analyzed sera of 79 patients with pancreatic cancer
and 169 with non-malignant diseases, chiefly consisting of hepatobiliary and pancreatic diseases. Serum CA 19-9 values in
patients with pancreatic cancer had no relation to the location of the tumor or presence of jaundice. Similarly, no tendency
was observed as to the location and size of tumor or to the grade of differentiation in 12 CA 19-9-negative patients with
pancreatic cancer. Serum levels of CA 19-9 in patients with cholelithiasis complicated by cholangitis frequently showed markedly
high values, but then rapidly normalized in parallel with the subsiding of inflammation. The behaviour of serum CA 19-9 showed
little relation to renal or hepatic failures or to intrahepatic cholestasis. However, slightly elevated levels of the antigen
were found in more than half of those patients with fulminant hepatitis showing massive necrosis. In chronic pancreatitis,
the prevalence was only 8%; however, an increase was observed at the time of exacerbation in 2 of 5 positive patients. There
was hardly any increase in serum levels of CA 19-9 after endoscopic retrograde cholangiopancreatography (ERCP), although serum
levels of pancreatic enzymes rose after ERCP in almost all patients. Thus, it appears that CA 19-9 does not easily escape
into the bloodstream, unlike pancreatic enzymes.
Journal of Gastroenterology 04/1986; 21(5):491-498. · 4.16 Impact Factor