Clinical features

Clinical presentation includes epigastric pain, pancreatitis, weight loss, diabetes, and jaundice {2169, 1953, 942}; some patients have no symptoms. Some cases are detected because of dilatation of the pancreatic duct seen incidentally in imaging studies. Serum amylase and lipase are commonly elevated. Endoscopic ultrasound, ERCP, and endoscopic examination of the pancreatic duct {1596} may all contribute to pre-

Fig. 10.21 Intraductal papillary-mucinous neoplasm. A Large neoplasm in the head of the pancreas containing multiple cystic spaces. B The lesion illustrated in A sectioned to demonstrate the dilated, mucin-filled main pancreatic duct (arrowheads).

operative diagnosis. Endoscopic biopsy or cytology may provide histological confirmation, but definitive diagnosis requires surgical removal and extensive histological sampling. Serum markers such as CEA and CA19-9 are too insensitive to be of value {2148, 1953}.

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