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Forum Name: Pancreatic Cancer

Question: Lesion on Pancreas


 dvk - Thu Jul 05, 2007 9:48 pm

Can you tell me what you think of this, Could it be an old injury, my lipase has been up and down since 2002. However I had a ct scan in November due to nasuea however i ended up being diagnosed a month later with celiac disease. I have followed my lipase periodical and my follow up ct said this.

I have had elevated Lipase never more than half of the upper limit on and off for 5 years, if the upper limit is 59 mine has never been more than 99. I have had ct scans twice and the last one came back as this. I am 33, male , no pain, I have Celiac Disease

On the images of the pancreas there is a questionable poorly defined 1cm lesion in the inferior aspect of the head of the pancreas best seen on image 28. On the thin section images the margins are somewhat indistinct and not as well defined. The remainder of the pancreas is unremarkable and with no pancreatic ductal dilation and the adjacent fat planes are preserved. No pancreatic calcifications, the splenic vein,portal vein, and smv are patent, no free or loculated fluid collections the bowel is not dilated. From old exam dated 11/2006 and in retrospect the area of the poorly defined low attenuation seen in the head of the pancreas was seen on that exam and is unchanged.

Impressions, There is a very subtle focal area of low attenuation in the inferior head of the pancreas which is poorly defined and marginated and measure slightly less than 1cm. No retrospect this has a similar appearance on the prior Ct exam of eight months ago and it without significant change. It is nonspecific and does not have the typical appearance of a mass though I could not exclude a small mass. It could also represent an area of focal Pancreatitis. I would recommend continued follow up since this has been stable over eight months I would recommend another follow up in approximately one year.
 Dr. Chan Lowe - Thu Jul 05, 2007 11:34 pm

User avatar A focal area of pancreatitis is possible given your repeated boughts of elevated lipase. (Although your lipase is not particularly high. With pancreatitis, the lipase can often reach into the thousand range.)

Given that it hasn't changed in 8 months it is less likely to be a cancer such as pancreatic cancer. It may simply be a normal variation that is being detected by the CT scan.

It is a good idea to follow it and I would agree with the recommendation for a repeat CT scan in a year based on the information provided.

As a note, lipase can be elevated due to reasons other than the pancreas as well. If your amylase is normal I would be more suspicious of the lipase being due to something other than your pancreas.

Best wishes.
 dvk - Sat Jul 07, 2007 9:03 pm

First of all I want to thank you for what you do here, there are so many people looking for answers when sometimes us Patients feel so alone and left in the dark.

I also had a question about what you said with it being possible that the ct scan is a normal variation being detected, Is it possible 2 have it 2 times? they had the radiologist actually 2 of them read this last one done and the CT from 8 months ago and both concurred that they saw it on the scan done 8 months ago Therefore it was there 8 months ago? And is it possible to have focal pancreatitis in that area for so long? Like I said before I have had elevated Lipase off and on for 5 years, the first test being on November 2002 which again all tests were normal back in 2002 including amylase however the lipase was 454 of a normal high of 300.

I had my lipase done the same day as the recent ct on July 3rd 2007 and it came back in normal range all my blood tests did, it was taken with amylase, all normal, bili, bun, magnesium, you name it.

Lipase I know can go up and down with having celiac disease which i do have, I also wonder about intestinal permeability. Or what else can do it since everything else is normal

I am so LOST AND WORRIED, im male 33 with 4 children and this scares the heck out of me.

Something tells me that I should go on with my life and not worry about it again, and live gluten free as I have and just be well, cause I do feel well other than the Food poisoning I had 3 weeks ago that set me back or should I have an MRI and does this have a better look than CT, I don’t want to mess with the Pancreas if I don’t need to. My GI seemed a little irrated that I even got another CT from my Primary DR and said lets do the MRI, and then we can do a biopsy,,he said to me "I know you are not worried about the cost so lets do it and resolve this once and for all for you" Meaning that I am pushing the issue and nothing is wrong but if its going to resolve it for me then Fine.

@ other questions besides above

1. I do have a small renal cyst and one small cyst on the liver they say is normal and has been there forever, they commented nothing other than its there on both CTs

2. what else causes Lipase increase? Celiac does I know that.

Thank you for everything and the rambling, but my GI is short with me like Im crazy!

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