J Korean Med Sci.  2011 Apr;26(4):583-586. 10.3346/jkms.2011.26.4.583.

Xanthogranulomatous Pancreatitis Presents as a Solid Tumor Mass: A Case Report

• Kim HS
• Joo M
• Chang SH
• Song HY
• Song TJ
• Seo JW
• Kim CN

• KMID: 1777893
• DOI: http://doi.org/10.3346/jkms.2011.26.4.583

Abstract

Xanthogranulomatous inflammation (XGI) is a rare, idiopathic process in which lipid-laden histiocytes are deposited at various locations in the body. Although XGI has been reported to occur in various organs such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, urachus, and urinary bladder and in soft tissues, xanthogranulomatous pancreatitis (XGP) is extremely rare. Herein, we report a case of XGP occurring in a 70-yr-old woman, who presented with abdominal pain for several months. On physical examination, mild epigastric tenderness was noted. Abdomen CT scan revealed a low attenuated mass in uncinate process of pancreas, suggesting malignant lesion. Whipple's operation was performed and the final pathologic diagnosis was XGP. The patient's post-operative course was uneventful, and no recurrence was found within 7 months of the operation. When a pancreatic mass does not show clinico-radiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis.

Keyword

Xanthogranulomatous; Inflammation; Pancreatitis; Neoplasms

MeSH Terms

Aged
Diagnosis, Differential
Duodenum/surgery
Female
Granuloma/complications/*diagnosis/pathology
Humans
Pancreas/surgery
Pancreatic Neoplasms/pathology
Pancreatitis/complications/*diagnosis/pathology
Positron-Emission Tomography
Tomography, X-Ray Computed
Xanthomatosis/complications/*diagnosis/pathology

Figure

• 

  Fig. 1 Radiologic images of the pancreatic mass. (A) Abdominopelvic computed tomography scan revealed a low attenuated mass with peripheral enhancing and lobulating contour at the pancreatic uncinate process (arrow). (B) Pancreas magnetic resonance imaging demonstrated a mass having heterogenous hyperintense with hypointensity of its margin on a T2-weighted image (arrow). (C) Positron emission tomography for a differential diagnosis showed strong fluorodeoxyglucose uptake in mass of pancreas uncinate process about 3 cm in size.

• 

  Fig. 2 Pathologic findings of the XGP. (A) Resected specimen shows an elliptical solid mass having bright yellow cut surface with fibrous septa (red arrows). (B) The xanthogranuloma extends into pancreatic parenchyma and peripancreatic adipose tissue. Dilatated peripheral ducts (yellow arrows), micropapillary proliferation of small duct (red arrows) and ductular proliferation (green arrows) are noted. (C) High power view reveals atrophy of acini and residual islets with inflammation (yellow arrows). (D) CD68 immunohistochemistry shows that strong positive xathogranuloma cells surround the acinus (red arrows).

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