Special US focusing on the pancreas and a set of serum tests were performed for patients with pancreatic duct dilatation(PDD) or pancreatic cysts(PC) every 3, 6 or 12 months. When some development was detected, additional examinations, including ERP with pancreatic juice cytology(PJC), were performed. To evaluate the rate of increase of pancreatic cancer in patients with PDD or PC compared with the normal population, the observed/expected(O/E) ratio was calculated by using the Osaka Cancer Registry. 1040 patients were registered for periodic checkups. Pancreatic cancer was detected in 17 patients. The O/E ratio of pancreatic cancer was significantly high in patients with PDD or PC. 8 patients with conventional pancreatic cancer excluding IPMC or MCC were in stage III-IVa. To improve the availability of this system for detecting early pancreatic cancer, we introduced MRCP, EUS-FNA, and recombinant secretin-loaded PJC in our new system.

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A 46-year-old man with alcoholism was admitted to our hospital complaining of fever and abdominal distension. Abdominal computed tomography(CT) revealed a huge pancreatic pseudocyst which expanded to the pelvic space with bacterial infection. The lesion was divided into two parts, one was in intra-abdominal space and another in the omental bursa. Because of the less effectiveness of conservative therapy, we performed percutaneous catheter drainage(PCD) using two catheters separately from each other. We carefully determined their positions for high effectiveness of drainage and intra-cystic lavage treatment. The size of the pseudocyst decreased and disappeared without surgical treatment. The follow-up CT at forty-five days after PCD showed occlusion of splenic vein, but it spontaneously improved.
We herein report a case of huge pancreatic pseudocyst presenting with unique morphology, because of its rarity and suggestive clinical course.

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The patient was an 11-year-old boy who suffered from acute lymphoblastic leukemia. After chemotherapy with L-asparaginase, he developed a pancreatic pseudocyst after acute pancreatitis that became enlarged and suppressed his stomach. Occasionally, the capsule of a pancreatic pseudocyst does not possess a true epithelial lining and is surrounded by fibrosis tissue filled with pancreatic debris, necrotic tissue, enzymes, blood, and fluids. Such pseudocysts should be drained by such techniques as surgical drainage, endoscopic drainage, and percutaneous drainage. We successfully perfomed cystgastrostomy for external drainage of the cyst with ultrasonic endoscopy. Endoscopic puncture seems to be useful as a treatment for pancreatic pseudocyst in children.

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A 58-year-old female visited our hospital because of a pancreatic head tumor that had been detected by CT during an examination for recurrent chronic pancreatitis. FDG-PET showed a strong accumulation at the same location as detected by CT. The SUV max for the tumor was 10.7.
Pylorus preserving pancreatoduodenectomy was performed under a preoperative diagnosis of pancreatic cancer.
Histopathological examination revealed moderately to poorly differentiated squamous carcinoma and moderately to well differentiated adenocarcinoma. It was diagnosed as an adenosquamous carcinoma of the pancreas.
Adenosquamous carcinoma is a very rare tumor of the pancreas. It accounts for 0.9% of pancreatic tumors by the Nation-wide Pancreatic Cancer Registry of Japan Pancreas Society.
Usually, the SUV of the common pancreatic cancer is less than 10 by FDG-PET. It is suggested that a pancreatic tumor with a SUV higher than 10 by FDG-PET could be a special pathological type of tumor other than common invasive pancreatic cancer.

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A 35-year-old man was found to have a tumor in the pancreas by ultrasonography. This was a solid and smooth margin tumor that was slightly enhanced in CT, and demonstrated low intensity on T1-weighted (WI), slightly high intensity on T2WI and high intensity on diffusion WI MRI. Positron emission computed tomography (PET) demonstrated a high uptake tumor with a maximum index of 4.9. This was diagnosed as pancreatic cancer and removed surgically. Histological diagnosis was a solid-pseudopapillary tumor (SPT). SPT usually affects young women and has several typical features. In this case, diagnosis was difficult because of atypical findings and high uptake in PET. In the future, smaller pancreatic tumors will be detected according to the progress in radiographic studies, and therefore the detection of small SPTs will increase. PET is useful but the findings of SPT have not been reported so much. We report an atypical SPT case and the difficulty of pre-operative diagnosis, especially with PET.

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