Analysis of the Causes of the Misdiagnosis of Mass Chronic Pancreatitis as Pancreatic Cancer and Literature Review

SHUAI Xuekang; LI Huimin; WU Qingming; GAO Shan

doi:10.3969/j.issn.1002-3429.2025.07.003

Abstract：Objective To investigate and analyze the causes of chronic pancreatitis with intractable abdominal pain and pancreatic mass as the main manifestations that was misdiagnosed as pancreatic cancer and the measures to prevent misdi-agnosis,so as to provide ideas and references for the diagnosis and treatment of this disease.Methods The clinical diagnosis and treatment of a chronic pancreatitis patient with atypical body and tail mass misdiagnosed as pancreatic cancer in February 2024 were analyzed,and the causes of misdiagnosis were analyzed combined with relevant literature.Results The main symptom of this patient was intractable upper abdominal and low back pain.There were no other obvious abnormalities in labo-ratory indicators except that random blood glucose,glycosylated hemoglobin and serum lipase were elevated at the first test.Enhanced CT scan and magnetic resonance imaging showed malignant tumor lesions in the body and tail of the pancreas.Fur-ther PET/CT and multiple examinations of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)showed no evi-dence of tumor.Conventional symptomatic and supportive treatment for chronic pancreatitis was given,but the effect was poor.After comprehensive analysis of the patient's condition,the preliminary diagnosis was a space-occupying lesion in the body and tail of the pancreas to be excluded,and the possibility of pancreatic cancer was considered.Laparoscopic exploration and pan-creatic body and tail resection were performed,and postoperative pathological examination showed chronic pancreatitis.The misdiagnosis lasted 2 months.At 6-month follow-up,the patient's abdominal pain was significantly relieved,blood glucose was well controlled,and the prognosis was good.Conclusion The main causes of the misdiagnosis of chronic pancreatitis with mass as pancreatic cancer are the high overlap of imaging manifestations of the two diseases,and EUS-FNA may have false negative results.To prevent misdiagnosis,it is necessary to combine the results of multi-site EUS-FNA and PET/CT examina-tion and dynamic observation.If conservative treatment is ineffective and the diagnosis is doubtful,early surgical exploration can be considered after fully weighing the advantages and disadvantages of surgery to confirm the diagnosis and carry out treat-ment.