Abstract
Ninety-five cases of pancreatic tumors were analysed with special reference to relationship between pancreatograms and histlogical types. They were cathegolized into six types which were normal pancreatogram, stenosis of the main pancreatic duct (MPD), obstruction of the MPD, dilatation of the MPD, dislocation of the MPD, and abnormal pancreatic field. They were further divided into subtypes. The classification was well related to histological types of pancreatic tumors, especially fibrous stroma, mode of extension, cystic formation, ability of mucus production. Most of the pancreatic tumors were differentiated tubular adenocarcinomas which were scirrhous and infiltrative, and their pancreatograms showed tapering stenosis, tapering obstruction, and pancreatic field defect. In medullaly and expansive tumors such as islet cell tumors, papillary adenocar-cinomas, and mucinous cystic tumors, their pancreatograms showed obstruction of the MPD with compression, dislocation of the MPD, and dislocation of branches. Papillary tumors tended to grow intraductaly, and the pancreatograms demonstrated proliferative changes at the site of stenosis and obstruction. Proliferative cysts showed two different types of pancreatograms. One demonstrated abnormal accumulation of contrast medium with filling defect, and the other had a factor of compression, and showed obstruction of the MPD with compression, or dislocation of the MPD. Mucinous cystic neoplasms were thought to relate to mucus producing adenocarcinomas of which the pancreatograms showed dilatation of the MPD or branches. Papillary tumors had a tendency to extend intraductaly, and differentiated tubular adenocarcinomas of which most pancreatic tumors consisted to grow periductaly. We can speculate the histological types of pancreatic tumors by our classification. So our classifi-cation is useful to make the diagnosis of tumor extension within the pancreas. A small pancreatic cancer less than 2 cm in diameter, mucus producing adenocar-cinoma, mucinous cystic tumor, and small tumor occurring near the MPD is expected to have a good prognosis. Even these pancreatograms revealed changes of the MPD such as stenosis or obstruction. It is concluded that routine ERCP would be a way to give an effective diagnosis of early pancreatic cancers.
