Chakraborty Partha Pratim, Dutta Deep, Biswas Kaushik, Sanyal Triranjan, Ghosh Sujoy, Mukhopadhyay Satinath, Chowdhury Subhankar
Departments of Endocrinology and Metabolism, IPGMER & SSKM Hospital, 244 AJC Bose Road, Kolkata, India.
Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S486-8. doi: 10.4103/2230-8210.104140.
Fibrocalcific pancreatic diabetes (FCPD) is a rare cause of diabetes (<1%) of uncertain etiology associated with >100-fold increased risk of pancreatic cancer. We present 3 patients of FCPD with pancreatic cancer who had long duration of diabetes (19 years, 25 years, and 28 years, respectively), all of whom presented with anorexia, weight loss, and worsened glycemic control. Patient-1 in addition presented with deep venous thrombosis. All the 3 patients had evidence of metastasis at the time of diagnosis. Computerized tomography (CT) abdomen revealed atrophic pancreas, dilated pancreatic ducts, and multiple calculi in the head, body, and tail of pancreas in all of them. Patient-1 had 38 mm × 38 mm × 32 mm mass in the tail of pancreas with multiple target lesions were seen in the right lobe of liver. Patient-2 had a mass in the tail of pancreas (46 × 34 × 31 mm) encasing the celiac plexus and superior mesenteric artery infiltrating the splenic hilum and splenic flexure of colon. Patient-3 also had a mass in the tail of pancreas (33 × 31 × 22 mm), with multiple target lesions in the liver, suggestive of metastasis. All patients had elevated serum CA19-9 (828.8, 179.65, and 232 U/L, respectively; normal <40 U/L). Patients of FCPD with anorexia, weight loss, worsening of glycemic control should be evaluated to rule out pancreatic cancer. Studies are warranted to evaluate CA19-9 as a screening tool for diagnosing pancreatic cancer at an earlier stage in FCPD.
纤维钙化性胰腺糖尿病（FCPD）是一种病因不明的罕见糖尿病病因（<1%），与胰腺癌风险增加100倍以上相关。我们报告了3例患有胰腺癌的FCPD患者，他们的糖尿病病程较长（分别为19年、25年和28年），均表现为厌食、体重减轻和血糖控制恶化。患者1还出现了深静脉血栓形成。所有3例患者在诊断时均有转移证据。腹部计算机断层扫描（CT）显示，他们所有人的胰腺均萎缩，胰管扩张，胰腺头部、体部和尾部有多个结石。患者1胰腺尾部有一个38 mm×38 mm×32 mm的肿块，肝脏右叶可见多个靶病变。患者2胰腺尾部有一个肿块（46×34×31 mm），包绕腹腔丛和肠系膜上动脉，浸润脾门和结肠脾曲。患者3胰腺尾部也有一个肿块（33×31×22 mm），肝脏有多个靶病变，提示转移。所有患者血清CA19-9均升高（分别为828.8、179.65和232 U/L；正常<40 U/L）。对于出现厌食、体重减轻、血糖控制恶化的FCPD患者，应进行评估以排除胰腺癌。有必要开展研究，评估CA19-9作为FCPD患者早期诊断胰腺癌的筛查工具。
