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4cm mass in pancreas tail

  I am 32 yr old female that initially went to internist for recurring severe stabbing pain in upper abdomen that radiated to upper back. Was prescribed prilosec for 4 weeks and have had no additional episodes. Also have recurring diarrhea that still continues, on occassion it is watery, but almost aways very small diameter and stringy. Internist sent me for ct scan after he felt an upper abdominal mass. Ct showed 4cm mass in the tail of the pancreas with focal enlargement- no other abnormalities and does not show a difference in density from rest of pancreas on scan.  Next test was ERCP which showed everything as normal. Apparently all blood test have been normal.  I am scheduled for fine needle aspiration biopsy this week and I have several questions. Could the diarrhea be related to the pancreas mass? What would be possible diagnosis in someone my age?
  Thank you
Dear Michelle,
The diarrhea can be related to a pancreatic mass. Chronic pancreatitis is often associated with diarrhea. Some rare tumors of the pancreas can also be associated with diarrhea. If the ERCP is normal and in fact a mass does exist,  it means that the mass does not communicate with the pancreatic duct or the biliary tree.  The most common lesion in a younger patient would be a cystic lesion. A cystic lesion is a collection of fluid that is surrounded by a wall of tissue. A pseudocyst is a collection of pancreatic juice enclosed by a thin wall of fibrous or granulomatous tissue.The most common cystic lesion in the pancreas is a pancreatic pseudocyst. 70-90% of  cystic lesions are pseudocysts. Pancreatic pseudocysts occur as a result of acute pancreatitis, chronic pancreatitis or pancreatic trauma. The most common causes of acute pancreatitis are alcohol related and gallstone related.  Primary cystic neoplasms (benign or malignant tumors) represent about 10-15% of lesions and the rest are rarer lesions. Adenocarcinoma of the pancreas is a solid mass lesion and occurs more commonly in elderly patients. Endocrine (hormone producing tumors) tumors of the pancreas are quite rare and present with solid masses as well. If the needle biopsy is not diagnostic another modality that may be helpful in diagnosis is an endoscopic ultrasound. This modality is usually available at university centers. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Ben-Menachem one of our experts in Gastroenterology and Pancreatico-biliary disorders.
*Keywords: pancreatic mass, differential diagnosis

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