Pancreatic carcinoma
Dear Sir or Madam,
I have been suffering from recurring abdominal pain attacks since roughly 2007. Numerous tests such as MRI, MRCP, CT (once in 2015), blood tests, stool examinations, etc. have been conducted consistently. In 2015, I was first seen by Prof. Dr. Uhl in Bochum (Pancreas Center).
In the summer of 2012, the suspicion of chronic pancreatitis was first raised (with Endosonography). This was confirmed in 2014 with Endosonography.
In 2015, further tests including CT, MRI, MRCP, stool, blood, ultrasound, etc. were performed in Bochum, and the suspicion remains.
My last examination was in February 2016, including MRI, MRCP, Endosonography, blood, and stool tests. The following results were obtained:
The report from the MRI/MRCP states:
"A previous examination from 18.02.2015 is available for comparison.
Homogeneous, non-fatty liver parenchyma without focal lesions. Unremarkable gallbladder with faint sedimented signal reductions in the dorsal aspect, consistent with Sludge. Normal width and configuration of the intra- and extrahepatic bile ducts.
Homogeneous pancreatic parenchyma without focal lesions. Two short-segment slight signal reductions of the pancreatic duct in the isthmus area and in the body with otherwise normal width and configuration, unchanged from the previous examination. No Pancreas divisum.
Normal appearance of the spleen without focal lesions.
Normal appearance of the kidneys and adrenal glands in size and shape.
No free fluid in the upper abdomen. Normal signal of the major arterial and venous structures in the upper abdomen. Scarred subcutaneous retraction in the right ventral mid-abdomen.
Assessment: No significant changes compared to a previous examination from 18.02.2015. Unchanged appearance of two short-segment small retractions of the pancreatic duct in the isthmus and body. No evidence of pancreatitis or suspicious pancreatic space-occupying lesion. Sludge in the gallbladder."
The report from the Endosonography states:
"Smooth insertion under visualization and advancement to the descending duodenum. Transduodenal and transbulbar, as well as transgastric examination of the liver parenchyma in the visible portions of the left liver lobe is unremarkable. Normal papillary region. Delicate choledochus duct without stones.
Normal sized, rather robust pancreas with discretely heterogeneous internal pattern. The parenchyma appears increasingly fibrotic in the head region, discretely lobulated in the body area. No focal points, no relevant pancreatic duct dilation, although the pancreatic duct appears slightly irregular in caliber with a maximum diameter of 2.8mm in the genu.
No pathological lymph nodes in the visible sections of the upper abdomen. No pathological lymph nodes transesophageally."
1. Discretely heterogeneous, slightly fibrotic-looking pancreatic parenchyma, discretely lobulated in the body area
- No focal points
- No relevant pancreatic duct dilation, although the pancreatic duct appears slightly irregular in caliber with a maximum diameter of 2.8mm in the genu
- Findings compatible with at most incipient chronic pancreatitis
My own stool tests for elastase and calprotectin have shown that the elastase has been over 500 for months (previously at 178, 200, 326, 478, etc.), but the calprotectin was at 220 a week ago and 101 this week. This calprotectin value has been elevated on and off in the past months.
1. My question now is, as I am experiencing increased back pain in the middle of my back, often higher up (feeling superficial, changing with movement or rotation), I am afraid that something may have been overlooked, or that a carcinoma may have developed within these 2 months, as chronic pancreatitis poses a risk.
2. Does the calprotectin value (I have read English studies on the relationship between the pancreas and calprotectin) indicate pancreatic carcinoma or chronic pancreatitis?
I would appreciate your assistance.
Sincerely, [Your Name]
