Chronic pancreatitis as a risk factor for pancreatic cancer (a clinical case)

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Abstract

The differential diagnosis between chronic pancreatitis   (CP) and  pancreatic   cancer  (PC) is a challenging  issue in the clinical practice, taking into account common  risk factors shared by these disorders   (smoking,  obesity,  diabetes   mellitus and insulin resistance), as well as a high risk of PC development  against  the  underlying  CP of 2 to 3 years' duration; this risk would  be  manifold  in hereditary CP. The article presents a clinical case of PC in a 60-year old man at three years after he had been  diagnosed with CP. The disease manifested from an acute  episode  of pancreatitis, which was treated in a hospital. Two years later, the  patient suffered from acute destructive pancreatitis complicated  by portal vein thrombosis and formation   of  pseudocysts.  Subsequently,  there was  a  rupture   of  the   post-necrotic  cyst  with leakage  into the  abdominal  cavity; this required surgical intervention. The differential diagnosis between CP and PC was done  at all steps  of the diagnostic work-up and treatment. However, afterthe inflammation  resolved, there  was a period of apparent well-being,  during  which  the  patient developed PC. This clinical case is intended to draw attention of clinicians, while making  differential diagnosis, to the detailed past history assessment, use of multiaxial computed tomography with intravenous      bolus      contrast      enhancement, and endoscopic  ultrasound examination  with elastography. In difficult cases, regular follow-up of at least every three months would be necessary.

About the authors

E. A. Dubtsova

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Author for correspondence.
Email: e.dubtsova@mknc.ru

Elena A. Dubtsova – MD, PhD, Head of Department of Pancreatic and Biliary Tract Pathology.

86 Shosse Entuziastov, Moscow, 111123.

Tel.: +7 (495) 304 00 60. 

Russian Federation

L. V. Vinokurova

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Lyudmila V. Vinokurova – MD, PhD, Leading Research Fellow, Department of Pancreatic and Biliary Tract Pathology.

86 Shosse Entuziastov, Moscow, 111123.

Russian Federation

K. A. Nikolskaya

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Karine A. Nikolskaya – MD, PhD, Senior Research Fellow, Department of Pancreatic and Biliary Tract Pathology.

86 Shosse Entuziastov, Moscow, 111123.

Russian Federation

M. A. Kiryukova

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Mariya A. Kiryukova – MD, Clinical Resident.

86 Shosse Entuziastov, Moscow, 111123.

Russian Federation

D. S. Bordin

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department; Tver State Medical University

Email: fake@neicon.ru

Dmitry S. Bordin – MD, PhD, Head of Division of Pathology of the Pancreas, Biliary Tract and Upper Digestive Tract The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department; Professor of Chair of General Medical Practice (Family Medicine), Faculty of Postgraduate Studies Tver State Medical University.

86 Shosse Entuziastov, Moscow, 111123; 4 Sovetskaya ul., Tver, 170100.

Russian Federation

References

  1. Al Haddad AH, Adrian TE. Challenges and future directions in therapeutics for pancreatic ductal adenocarcinoma. Expert Opin Investig Drugs. 2014;23(11):1499–515. doi: 10.1517/13543784.2014.933206.
  2. Котельников АГ, Патютко ЮИ, Трякин АА. Клинические рекомендации по диагностике и лечению злокачественных опухолей поджелудочной железы. М.; 2014. 44 с. [Интернет]. Доступно на: http://www.oncology.ru/association/clinical-guidelines/2014/35. pdf.
  3. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. doi: 10.3322/caac.21208.
  4. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252–61. doi: 10.1053/j.gastro.2013.01.068.
  5. Midha S, Sreenivas V, Kabra M, Chattopadhyay TK, Joshi YK, Garg PK. Genetically determined chronic pancreatitis but not alcoholic pancreatitis is a strong risk factor for pancreatic cancer. Pancreas. 2016;45(10):1478–84. doi: 10.1097/MPA.0000000000000684.
  6. Krejs GJ. Pancreatic cancer: epidemiology and risk factors. Dig Dis. 2010;28(2):355–8. doi: 10.1159/000319414.
  7. Bartosch-Härlid A, Andersson R. Diabetes mellitus in pancreatic cancer and the need for diagnosis of asymptomatic disease. Pancreatology. 2010;10(4):423–8. doi: 10.1159/000264676.
  8. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol. 2010;24(3):349–58. doi: 10.1016/j.bpg.2010.02.007.
  9. Rebours V, Boutron-Ruault MC, Schnee M, Férec C, Maire F, Hammel P, Ruszniewski P, Lévy P. Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series. Am J Gastroenterol. 2008;103(1):111–9. doi: 10.1111/j.1572-0241.2007.01597.x.
  10. Rebours V, Boutron-Ruault MC, Schnee M, Férec C, Le Maréchal C, Hentic O, Maire F, Hammel P, Ruszniewski P, Lévy P. The natural history of hereditary pancreatitis: a national series. Gut. 2009;58(1):97–103. doi: 10.1136/gut.2008.149179.
  11. Чистяков СС, ред. Онкология для практикующих врачей. М.: КМК, Авторская академия; 2009. 634 с.
  12. Crnogorac-Jurcevic T, Gangeswaran R, Bhakta V, Capurso G, Lattimore S, Akada M, Sunamura M, Prime W, Campbell F, Brentnall TA, Costello E, Neoptolemos J, Lemoine NR. Proteomic analysis of chronic pancreatitis and pancreatic adenocarcinoma. Gastroenterology. 2005;129(5):1454–63. doi: 10.1053/j.gastro.2005.08.012.
  13. Bracci PM, Wang F, Hassan MM, Gupta S, Li D, Holly EA. Pancreatitis and pancreatic cancer in two large pooled case-control studies. Cancer Causes Control. 2009;20(9):1723–31. doi: 10.1007/s10552-009-9424-x.
  14. Kirkegård J, Mortensen FV, Cronin-Fenton D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol. 2017;112(9):1366–72. doi: 10.1038/ajg.2017.218.
  15. Hao L, Zeng XP, Xin L, Wang D, Pan J, Bi YW, Ji JT, Du TT, Lin JH, Zhang D, Ye B, Zou WB, Chen H, Xie T, Li BR, Zheng ZH, Wang T, Guo HL, Liao Z, Li ZS, Hu LH. Incidence of and risk factors for pancreatic cancer in chronic pancreatitis: A cohort of 1656 patients. Dig Liver Dis. 2017;49(11):1249–56. doi: 10.1016/j.dld.2017.07.001.
  16. Tolstrup JS, Kristiansen L, Becker U, Grønbaek M. Smoking and risk of acute and chronic pancreatitis among women and men: a population-based cohort study. Arch Intern Med. 2009;169(6):603–9. doi: 10.1001/archinternmed.2008.601.
  17. Хатьков ИЕ, Маев ИВ, Абдулхаков СР, Алексеенко СА, Алиева ЭИ, Алиханов РБ, Бакулин ИГ, Барановский АЮ, Белобородова ЕВ, Белоусова ЕА, Буриев ИМ, Быстровская ЕВ, Вертянкин СВ, Винокурова ЛВ, Гальперин ЭИ, Горелов АВ, Гриневич ВБ, Данилов МВ, Дарвин ВВ, Дубцова ЕА, Дюжева ТГ, Егоров ВИ, Ефанов МГ, Захарова НВ, Загайнов ВЕ, Ивашкин ВТ, Израилов РЕ, Корочанская НВ, Корниенко ЕА, Коробка ВЛ, Коханенко НЮ, Кучерявый ЮА, Ливзан МА, Лоранская ИД, Никольская КА, Осипенко МФ, Охлобыстин АВ, Пасечников ВД, Плотникова ЕЮ, Полякова СИ, Саблин ОА, Симаненков ВИ, Урсова НИ, Цвиркун ВВ, Цуканов ВВ, Шабунин АВ, Бордин ДС. Российский консенсус по диагностике и лечению хронического панкреатита. Терапевтический архив. 2017;89(2):105–13. doi: 10.17116/terarkh2017892105-113.
  18. Pelucchi C, Galeone C, Polesel J, Manzari M, Zucchetto A, Talamini R, Franceschi S, Negri E, La Vecchia C. Smoking and body mass index and survival in pancreatic cancer patients. Pancreas. 2014;43(1):47–52. doi: 10.1097/MPA.0b013e3182a7c74b.
  19. Genkinger JM, Spiegelman D, Anderson KE, Bergkvist L, Bernstein L, van den Brandt PA, English DR, Freudenheim JL, Fuchs CS, Giles GG, Giovannucci E, Hankinson SE, Horn-Ross PL, Leitzmann M, Männistö S, Marshall JR, McCullough ML, Miller AB, Reding DJ, Robien K, Rohan TE, Schatzkin A, Stevens VL, Stolzenberg-Solomon RZ, Verhage BA, Wolk A, Ziegler RG, Smith-Warner SA. Alcohol intake and pancreatic cancer risk: a pooled analysis of fourteen cohort studies. Cancer Epidemiol Biomarkers Prev. 2009;18(3):765–76. doi: 10.1158/1055-9965.EPI-08-0880.
  20. Lucenteforte E, La Vecchia C, Silverman D, Petersen GM, Bracci PM, Ji BT, Bosetti C, Li D, Gallinger S, Miller AB, Bueno-de-Mesquita HB, Talamini R, Polesel J, Ghadirian P, Baghurst PA, Zatonski W, Fontham E, Bamlet WR, Holly EA, Gao YT, Negri E, Hassan M, Cotterchio M, Su J, Maisonneuve P, Boffetta P, Duell EJ. Alcohol consumption and pancreatic cancer: a pooled analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol. 2012;23(2):374–82. doi: 10.1093/annonc/mdr120.
  21. Bharmal SH, Pendharkar SA, Singh RG, Goodarzi MO, Pandol SJ, Petrov MS. Relationship between circulating levels of pancreatic proteolytic enzymes and pancreatic hormones. Pancreatology. 2017;17(6):876–83. doi: 10.1016/j.pan.2017.09.007.
  22. Христич ТН. Роль персистенции хронической воспалительной реакции при хроническом панкреатите в развитии рака поджелудочной железы (обзор литературных и собственных данных). Крымский терапевтический журнал. 2013;(2):15–20.
  23. Hart PA, Bellin MD, Andersen DK, Bradley D, Cruz-Monserrate Z, Forsmark CE, Goodarzi MO, Habtezion A, Korc M, Kudva YC, Pandol SJ, Ya-dav D, Chari ST; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC). Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol. 2016;1(3):226–37. doi: 10.1016/S2468-1253(16)30106-6.
  24. Schneider A, Löhr JM, Singer MV. The M-ANN-HEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2007;42(2): 101–19. doi: 10.1007/s00535-006-1945-4.
  25. Schlieman MG, Ho HS, Bold RJ. Utility of tumor markers in determining resectability of pancreatic cancer. Arch Surg. 2003;138(9):951–5. doi: 10.1001/archsurg.138.9.951.
  26. Su SB, Qin SY, Chen W, Luo W, Jiang HX. Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis. World J Gastroenterol. 2015;21(14): 4323–33. doi: 10.3748/wjg.v21.i14.4323.

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Copyright (c) 2018 Dubtsova E.A., Vinokurova L.V., Nikolskaya K.A., Kiryukova M.A., Bordin D.S.

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