Is tropical pancreatitis premalignant?

Pancreatic adenocarcinoma occurred in 22 of 266 patients with tropical pancreatitis presenting over an 8-yr period (8.3%). We compared the data on three groups: group 1, patients with tropical pancreatitis (benign, n = 82); group 2, tropical pancreatitis with super-imposed malignancy (n = 22), and group 3, those with de novo cancer (n = 76). Factors associated with high risk for cancer in tropical pancreatitis were age greater than 40 yr, short symptom duration, weight loss, mass on ultrasound, and ductal block on endoscopic retrograde cholangiopancreatography. Tropical pancreatic cancers had distinct differences from de novo cancers: younger mean age (47 vs. 61 yr), calculi in all (vs. none in group 3), diabetes in 16 of 22 (73%) versus 18 of 76 (24%), and tumors in body and tail in 16 of 22 (73%) versus 26 of 76 patients (34%). In group 2, survival was poorer (10 vs. 17 months, p less than 0.01) than in group 3 (those with de novo cancer). Two of five resected specimens in group 2 showed features of dysplasia, in addition to cancer. Tropical pancreatitis has a high association with cancer. Malignancy occurring in tropical pancreatitis is distinct from de novo cancer. When considered in the light of the low incidence of pancreatic cancer in southern India, the above evidence suggests a possible etiological relationship.