Nonductal tumors of the pancreas. The importance of laparotomy
S. A. De Jong, J. Pickleman and K. Rainsford
Department of Surgery, Loyola University Medical Center, Maywood, Ill.
OBJECTIVES: To delineate the incidence of nonductal pancreatic neoplasms
and determine whether distinguishing clinical or radiologic characteristics
exist. METHODS: From 1977 through 1990, we examined 353 patients with a
pancreatic mass as demonstrated on abdominal computed tomography or
ultrasonography. Patients with chronic pancreatitis or functioning
neuroendocrine tumors were excluded. All patients underwent operative
exploration for histopathologic diagnosis and resection when possible.
RESULTS: Adenocarcinoma of the pancreas was seen in 322 patients. The
remaining 31 patients (8.8%) were found to have nonductal tumors of the
pancreas, including nonfunctioning islet cell tumors (15), cystadenoma
(nine), lymphoma (five), lipoma (one), and mesothelioma (one). These
neoplasms were evenly distributed between the head and tail of the
pancreas, while most of the ductal pancreatic carcinomas were located in
the pancreatic head. While abdominal computed tomography and
ultrasonography accurately identified most cystic neoplasms, the remaining
nonductal lesions were indistinguishable from ductal pancreatic tumors.
Preoperative biochemical studies and liver function tests failed to
separate ductal and nonductal pancreatic masses. Average survival for
patients with nonductal lesions was significantly longer compared with
ductal tumors of the pancreas. CONCLUSIONS: Because increasing reliance on
advanced radiologic and invasive nonoperative diagnostic testing may deny
proper surgical therapy to patients with nonductal neoplasms of the
pancreas, laparotomy and histopathologic diagnosis are advisable in most
patients with an isolated pancreatic mass.
