Small carcinoma of the pancreas is curable: New computed tomography finding, pathological study and postoperative results from a single institute

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Abstract
Background: It is well known that pancreatic cancer is rarely cured and is usually fatal. The clinicopathological features of small (greatest dimension ≤ 2 cm by histologic measurement) carcinoma of the pancreas (s‐PC), were reviewed, paying special attention to new computed tomography (CT) finding that suggests the presence of s‐PC.Methodology: Sixteen patients with s‐PC have undergone curative surgery at Aichi Cancer Center Hospital during the past 11 years. Their preoperative diagnostic findings, pathological findings and postoperative prognoses were analyzed.Results: The most useful diagnostic clue was dilatation of the main pancreatic duct (MPD). It was difficult to identify the tumor in four patients because of pancreatitis accompanying the MPD obstruction. In three of these four cases, early phase‐enhanced CT revealed a contrasting effect between the proximal and distal sides of the pancreatic parenchyma at the site of the MPD obstruction (black & white sign). The longest diameters of the tumors ranged from 0.9 to 2 cm (average 1.3 cm). Positive rates of capsular invasion, retroperitoneal invasion, and lymph node metastasis were 6.3% (1/16), 31.3% (5/16), and 18.8% (3/16), respectively. Six patients (37.5%) were classed at stage I, six (37.5%) stage II, three (18.8%) stage III, and one (6.2%) at stage IV according to pathological TNM classification. One patient died of the disease, and the cumulative 3‐ and 5‐year survival rates were 88.9% and 59.3%, respectively.Conclusions: The presence of s‐PC qualifies as early PC and has a good prognosis. The CT black + white sign will be useful in the diagnosis of s‐PC accompanying pancreatitis.