Korean J Radiol.  2015 Dec;16(6):1253-1256. 10.3348/kjr.2015.16.6.1253.

Pancreatic Candidiasis That Mimics a Malignant Pancreatic Cystic Tumor on Magnetic Resonance Imaging: A Case Report in an Immunocompetent Patient

• Seong M
• Kang TW
• Ha SY

• KMID: 2344278
• DOI: http://doi.org/10.3348/kjr.2015.16.6.1253

Abstract

Candida is a commensal organism that is frequently found in the human gastrointestinal tract. It is the most common organism that causes pancreatic fungal infections. However, magnetic resonance imaging findings of Candida infection in the pancreas have not been described. We report imaging findings of pancreatic candidiasis in a patient in immunocompetent condition. It presented as a multi-septated cystic mass with a peripheral solid component in the background of pancreatitis and restricted diffusion on diffusion-weighted image that mimicked a malignant pancreatic cystic tumor.

Keyword

Pancreas; Candida; Infection; Magnetic resonance imaging

MeSH Terms

Candida/pathogenicity
Candidiasis/*diagnosis/microbiology/radiography
Diagnosis, Differential
Humans
Immunocompromised Host
Magnetic Resonance Imaging/methods
Male
Middle Aged
Pancreatic Neoplasms/*diagnosis/radiography
Pancreatitis/*diagnosis/microbiology/radiography

Figure

• 

  Fig. 1 Pancreatic candidiasis in 56-year-old man. A. On axial CT scan obtained at portal phase, 3.4 cm multi-septated cystic lesion with lobulating contour (white arrow) is observed between body and tail of pancreas. Pancreas tissue around lesion is mildly swollen (asterisk). B. On T2-weighted axial MR image, cystic mass (black arrow) has relatively low signal intensity component compared with adjacent swollen pancreas (asterisk) at periphery and internal thick septa. C. In dynamic enhancement study, thick peripheral portion and internal septa of tumor (white arrow) are enhanced. Non-enhanced portion (asterisk) matches region of hyperintensity on T2-weighted image, indicating necrotic portion or cystic component of mass. D. On diffusion-weighted image with b-value of 800, lesion (white arrow) shows high signal intensity. E. Apparent diffusion coefficient value of corresponding area is low, indicating presence of diffusion restriction (white arrow). F. Gomori's methenamine-silver staining highlights multiple fungal hyphae, consistent with Candida species (× 200).

Reference

1. Hoerauf A, Hammer S, Müller-Myhsok B, Rupprecht H. Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality. Crit Care Med. 1998; 26:2010–2015.

2. Kochhar R, Noor MT, Wig J. Fungal infections in severe acute pancreatitis. J Gastroenterol Hepatol. 2011; 26:952–959.

3. Pugliese F, Ruberto F, Cappannoli A, Perrella SM, Bruno K, Martelli S, et al. Incidence of fungal infections in a solid organ recipients dedicated intensive care unit. Transplant Proc. 2007; 39:2005–2007.

4. Reeders JW, Yee J, Gore RM, Miller FH, Megibow AJ. Gastrointestinal infection in the immunocompromised (AIDS) patient. Eur Radiol. 2004; 14:Suppl 3. E84–E102.

5. Shanmugam N, Isenmann R, Barkin JS, Beger HG. Pancreatic fungal infection. Pancreas. 2003; 27:133–138.

6. Gregory DW. Saturday Conference: Candida infections. South Med J. 1982; 75:339–345.

7. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. CARE Group. The CARE guidelines: consensus-based clinical case report guideline development. J Clin Epidemiol. 2014; 67:46–51.

8. Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010; 50:1101–1111.

9. Howard JM, Bieluch VM. Pancreatic abscess secondary to Candida albicans. Pancreas. 1989; 4:120–122.

10. Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR. MR imaging of cystic lesions of the pancreas. Radiographics. 2009; 29:1749–1765.

11. Wang Y, Miller FH, Chen ZE, Merrick L, Mortele KJ, Hoff FL, et al. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics. 2011; 31:E47–E64.