Adénocarcinome du pancréas sur pancréatite chronique calcifiante
Development of pancreatic adenocarcinoma in chronic calcifying pancreatitis
The malignant degeneration of the pancreatic parenchyma on a chronic calcifying pancreatitis (CCP) is very rare. It happens in 4% of patients during the twenty years following the diagnosis of a chronic pancreatitis (CP). We report an observation of a pancreatic adenocarcinoma (PAC) with CCP in a 51-year old female patient, pointing out the diagnostic difficulties created by this rare complication with nonspecific symptoms and imagery.
A nonsmoking, nondrinking, 51-year old woman was hospitalised for epigastric pain of pancreatic type associated with malabsorption diarrhoea. The clinical diagnosis found epigastric sensitivity. The abdominal ultrasound and the abdominal tomodensitometry showed the aspect of a CP evolved with intraductal pancreatic calcifications leading hence to the diagnosis of PCC. The etiologic assessment was negative and the patient has benefited from a symptomatic treatment based on pancreatic extracts and analgesics, but with the persistence and even the worsening of the pancreatic pain, she was entrusted to a surgeon for a derivation. At the fifth postoperative day, the patient presented severe epigastric pain of pancreatic type. The morphologic examination showed at the level of the pancreas head a heterogeneous image which led to a second surgery and the histological study concluded to a PAC.
The pancreatic cancer on a CP is still a rare complication, the diagnosis is difficult and is frequently made late because of the unspecific symptoms; thus a rigorous follow up of patients with PCC should be instaured, probably through a series of CA19.9 associated with percutaneous biopsies when the values are increased or when new symptoms appear.
Nisrine BELARBI, Imane BENELBARHDADI, Mounia ZAHZAH, Rajae AFIFI, M. BENAZZOUZ, A. ESSAID, R. MOHSINE, S. BALAFREJ
pancreatic adenocarcinoma, chronic calcifying pancreatitis