Calcifying obstructive pancreatitis

A study of intraductal papillary mucinous neoplasm associated with pancreatic calcification

Mauricio Zapiach, Dhiraj Yadav, Thomas Christopher Smyrk, Joel Garland Fletcher, Randall K. Pearson, Jonathan E. Clain, Michael B. Farnell, Suresh T Chari

Research output: Contribution to journalArticle

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Abstract

Background & Aims: We have observed intraductal papillary mucinous neoplasm (IPMN) associated with pancreatic calcification. The aim of this study is to describe the profile of IPMN associated with calcification and gain insights into the pathogenesis of calcification in IPMN. Methods: We identified 10 patients with IPMN with pancreatic calcification, of whom 7 underwent pancreatic resection. We reviewed demographic data, history of previous pancreatitis, and radiological and histological features of these patients. Results: In patients with IPMN with calcification (mean age, 65 ± 12 yr; 50% men), a diagnosis of chronic calcifying pancreatitis was entertained in 5 of 10 patients; 2 patients had undergone previous endoscopic therapy for stone removal. There was no previous history of pancreatitis in 9 of 10 patients. Radiologically, calcifications were seen diffusely throughout the gland in 8 of 10 patients and interpreted as chronic calcific pancreatitis. Although 1 of the 7 patients who underwent resection had diffuse IPMN throughout the gland, 6 patients had IPMN confined to the head or uncinate process (mean size, 2.75 cm; range, 1.1-5 cm). Histologically, 6 of 7 IPMNs were adenomas, and 1 patient had invasive cancer. No patient had intratumoral calcification. All 7 patients had calcification within the main pancreatic duct and/or side branches, often within inspissated mucus. Conclusions: IPMN associated with pancreatic calcification can lead to misdiagnosis and inappropriate treatment for chronic calcifying pancreatitis. In the absence of intratumoral calcification or a previous history of long-standing chronic pancreatitis, calcification in IPMN likely represents a unique and hitherto unrecognized form of calcifying obstructive pancreatitis caused by prolonged partial obstruction of the pancreatic duct.

Original languageEnglish (US)
Pages (from-to)57-63
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume2
Issue number1
DOIs
StatePublished - Jan 2004

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Pancreatitis
Neoplasms
Chronic Pancreatitis
Pancreatic Ducts
Mucus
Diagnostic Errors
Pancreatic Neoplasms
Adenoma
Head
Demography

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Calcifying obstructive pancreatitis : A study of intraductal papillary mucinous neoplasm associated with pancreatic calcification. / Zapiach, Mauricio; Yadav, Dhiraj; Smyrk, Thomas Christopher; Fletcher, Joel Garland; Pearson, Randall K.; Clain, Jonathan E.; Farnell, Michael B.; Chari, Suresh T.

In: Clinical Gastroenterology and Hepatology, Vol. 2, No. 1, 01.2004, p. 57-63.

Research output: Contribution to journalArticle

Zapiach, Mauricio ; Yadav, Dhiraj ; Smyrk, Thomas Christopher ; Fletcher, Joel Garland ; Pearson, Randall K. ; Clain, Jonathan E. ; Farnell, Michael B. ; Chari, Suresh T. / Calcifying obstructive pancreatitis : A study of intraductal papillary mucinous neoplasm associated with pancreatic calcification. In: Clinical Gastroenterology and Hepatology. 2004 ; Vol. 2, No. 1. pp. 57-63.
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abstract = "Background & Aims: We have observed intraductal papillary mucinous neoplasm (IPMN) associated with pancreatic calcification. The aim of this study is to describe the profile of IPMN associated with calcification and gain insights into the pathogenesis of calcification in IPMN. Methods: We identified 10 patients with IPMN with pancreatic calcification, of whom 7 underwent pancreatic resection. We reviewed demographic data, history of previous pancreatitis, and radiological and histological features of these patients. Results: In patients with IPMN with calcification (mean age, 65 ± 12 yr; 50{\%} men), a diagnosis of chronic calcifying pancreatitis was entertained in 5 of 10 patients; 2 patients had undergone previous endoscopic therapy for stone removal. There was no previous history of pancreatitis in 9 of 10 patients. Radiologically, calcifications were seen diffusely throughout the gland in 8 of 10 patients and interpreted as chronic calcific pancreatitis. Although 1 of the 7 patients who underwent resection had diffuse IPMN throughout the gland, 6 patients had IPMN confined to the head or uncinate process (mean size, 2.75 cm; range, 1.1-5 cm). Histologically, 6 of 7 IPMNs were adenomas, and 1 patient had invasive cancer. No patient had intratumoral calcification. All 7 patients had calcification within the main pancreatic duct and/or side branches, often within inspissated mucus. Conclusions: IPMN associated with pancreatic calcification can lead to misdiagnosis and inappropriate treatment for chronic calcifying pancreatitis. In the absence of intratumoral calcification or a previous history of long-standing chronic pancreatitis, calcification in IPMN likely represents a unique and hitherto unrecognized form of calcifying obstructive pancreatitis caused by prolonged partial obstruction of the pancreatic duct.",
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