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HYPOTHESIS: Chronic pancreatitis is a risk factor for pancreatic cancer. The association between these 2 disease processes is not well known. We present 3 unusual cases of pancreatitis associated with pancreatic cancer and review the possible mechanisms that can cause pancreatitis to degenerate into pancreatic cancer. DESIGN: A case series reviewing 3 unusual cases of chronic pancreatitis associated with pancreatic cancer. The patients' charts are reviewed, and a literature search is performed looking for chronic pancreatitis associated with pancreatic cancer. SETTING: The cases were performed at a small community hospital in New York City, New York. PARTICIPANTS: The surgeons involved are experienced pancreatic surgeons with a large referral group. The endoscopies were performed by gastroenterologists with years of experience in biliary and pancreatic disease. RESULTS: The cases and the literature review support the hypothesis that there is an association between chronic pancreatitis and pancreatic cancer. CONCLUSIONS: Three unusual case of chronic pancreatitis, 2 with synchronous and 1 with metachronous malignancies, are presented. The pathway of benign to malignant change is reviewed, and the constant awareness that pancreatitis is associated with malignancy must be kept in mind.