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

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.