Cancer of the pancreas with hyperamylasemia

A 66-yr-old woman had several attacks resembling relapsing acute pancreatitis with elevation of serum amylase for about three months. Obstruction of the main pancreatic duct was detected with endoscopic retrograde pancreatoductography, though no abnormality was revealed on celiac and mesenteric arteriograms. At that time she had no jaundice. Laparotomy revealed a walnut-sized tumor in the head of the pancreas compressing the main pancreatic duct. Pancreaticoduodenectomy was performed. The pathological diagnosis of the tumor was well-differentiated papillary cysto-adenocarcinoma of the pancreas. She had no attack of hyperamylasemia since the operation, and is well 2 years after the surgery. Close attention to persistent elevation of pancreatic amylase levels in serum and urine would enhance the chance of detection of small pancreatic cancers before the development of jaundice.