Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer

Gastrointest Endosc. 1997 Nov;46(5):417-23. doi: 10.1016/s0016-5107(97)70034-8.


Background: The differentiation between cancer and benign disease in the pancreatic head is difficult. The aim of this study was to examine common features in a group of patients that had undergone pancreatoduodenectomy for a benign, inflammatory lesion misdiagnosed as pancreatic head cancer.

Methods: Among 220 pancreatoduodenectomies performed on the suspiscion of pancreatic head cancer, an inflammatory lesion in the pancreas or distal common bile duct was diagnosed in 14 patients (6%). Of these patients, all preoperative clinical information and radiologic images (ultrasound, endoscopic retrograde cholangio-pancreaticography [ERCP]) were critically reassessed. For each examination, the suspicion of cancer was scored on a 0/+/++ scale.

Results: Clinical presentation (pain, weight loss, jaundice) raised a suspicion of cancer in 12 patients. On ultrasound, a tumor (mean size: 2.8 cm) was found in the pancreatic head in 13 patients; 12 of 14 ultrasound examinations raised a suspicion of cancer. ERCP showed a distal common bile duct stenosis (length: 1 to 4 cm), stenosis of the pancreatic duct (length: 1 to 5 cm), or a "double duct" stenosis, suspicious for cancer in 13 evaluable patients. The overall index of suspicion was + in seven patients and ++ in seven patients, confirming the initial interpretation of preoperative data.

Conclusion: When undertaking pancreatoduodenectomy for a suspicious lesion in the pancreatic head, it is necessary to expect at least a 5% chance of resecting a benign, inflammatory lesion masquerading as cancer.

MeSH terms

  • Cholangiopancreatography, Endoscopic Retrograde
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Diseases / diagnosis
  • Pancreatic Diseases / diagnostic imaging
  • Pancreatic Diseases / surgery
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / surgery
  • Pancreaticoduodenectomy
  • Ultrasonography