Die Unterscheidung zwischen malignen und benignen Läsionen im retrograden Pankreatikogramm

Abstract

The accuracy of ERCP in the differentiation between carcinoma of the pancreas and chronic pancreatitis is evaluated in a series of 39 cases with proved final diagnosis. The specificity of 6 different morphological types of duct alterations for carcinoma or for chronic pacreatitis is analyzed. - The accuracy of differentiation was 90% in the present series. Long, irregular stenosis or localized destruction of ductal branches were found in carcinoma only. Short, smooth stenosis or diffuse duct alterations were present in pancreatitis only. Total obstruction was found in both diseases in about the same frequency.

Pseudotumorous pancreatitis

“…To distinguish benign from malignant pancreatic disease, ERCP is considered the most accurate procedure [4,11]. Nevertheless, pancreatitis can mimic almost any ductal alteration.…”

“…B Histologic specimen: chronic pancreatitis, islet cells apposed to a nerve bundle, relative increase in number of islets of Langerhans (aldehyde -fuchsin stain). C Histologic specimen (HE stain): islet cells in perineural tissue, possible atypical islet cell at 5 o'clock; however, a benign invasion due to the adjacent proliferative process is more likely with solitary, long, and irregular stenoses or with obstruction unaccompanied by inflammation in the remaining pancreas, a reliable differentiation becomes impossible [11,12]. Since pseudotumorous pancreatitis constitutes an unusually large early focal pancreatitis, the remaining pancreas does not show the inflammatory changes normally expected in chronic pancreatitis.…”