Pancreatic Neoplasms -- Printable Tables

TITLE:	PANCREATIC NEOPLASMS
AUTHORS:	TYLER STEVENS, MD -- Department of Gastroenterology and Hepatology
	DARWIN L. CONWELL, MD -- Department of Gastroenterology and Hepatology
PUBLISHED:	MAY 12, 2005

Table 1:
Pancreatic Neuroendocrine Tumors
Tumor Type	%^A	Secretory Product	Clinical Features	Laboratory Testing	Symptomatic Treatment
Insulinoma	40-60	Insulin	Hypoglycemia Symptoms of catecholamine excess 90% benign	Insulin level/ C-peptide 72-hour inpatient fast with monitoring of glucose and insulin levels	Dietary measures Octreotide Diazoxide
Gastrinoma	20-50	Gastrin	Peptic ulcer disease GERD Secretory diarrhea Most common NET in MEN 1 60% to 90% malignant	Fasting serum gastrin Gastric pH analysis Gastrin provocation testing (calcium or secretin challenge)	Proton pump inhibitor Octreotide
Glucagonoma	Rare	Glucagon	Glucose intolerance Migratory necrolytic erythema Weight loss Anemia 90% malignant	Serum glucagon	Octreotide Insulin Zinc supplement (rash) TPN (malnutrition)
Somatostatinoma	Rare	Somatostatin	Diabetes Gallstones Secretory diarrhea	Clinical and pathologic diagnosis Increased somatostatin-like immunoreactivity in resected tumor	Octreotide
VIPoma	Rare	Vasoactive intestinal peptide	Cholera-like, secretory diarrhea Hypokalemia Hypochlorhydria	Serum VIP	Octreotide
^APercent among neuroendocrine tumors, GERD = gastroesophageal reflux disease; MEN 1 = multiple endocrine neoplasia type 1; NET = neuroendocrine tumor; TPN = total parenteral nutrition; VIP = vasoactive intestinal peptide

Table 2:
Types of Pancreatic Cysts
Type	Demographic	Malignant Potential	Location In Pancreas	Radiographic Features	Cyst Fluid Analysis
Pseudocyst	History of pancreatitis	No	Throughout	Unilocular Thick-walled	Elevated amylase
Serous cystadenoma	Middle-aged woman	No	Throughout	Multicystic Calcifications Central scar	Elevated Ca19-9
Mucinous cystadenoma or cystadenocarcinoma	Middle-aged woman	Yes	Body and tail	One or few cysts Thick or irregular walls	Positive mucin stain Elevated CEA Positive cytology
Intrapapillary mucinous neoplasia	Middle-aged and older men	Yes	Diffuse or localized	Pancreatic duct dilation Papillary projections
Papillary cystic neoplasm	Rare Young women	Yes Locally aggressive	Body and tail

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