Investig Magn Reson Imaging.  2016 Sep;20(3):185-190. 10.13104/imri.2016.20.3.185.

Xanthogranulomatous Pancreatitis Mimicking a Pancreatic Cancer on CT and MRI: a Case Report and Literature Review

• Park JM
• Cho SH
• Bae HI
• Seo AN
• Kim HJ
• Lee SM
• Yi JH
• Lim JK
• Cho CM

• KMID: 2354800
• DOI: http://doi.org/10.13104/imri.2016.20.3.185

Abstract

Xanthogranulomatous inflammation is a rare benign condition involving various organs. However, its pancreas involvement is very rare. To the best of our knowledge, only 17 cases have been described in the literature. Interestingly, all reported 17 cases due to various causes underwent surgical resection. Here, we present a case of xanthogranulomatous pancreatitis in a 63-year-old man. He presented with epigastric pain and solid mass mimicking ductal adenocarcinoma in the body and tail of pancreas on magnetic resonance imaging. The patient was diagnosed as xanthogranulomatous pancreatitis via endoscopic ultrasound-guided fine needle aspiration. After that, he was followed up and monitored without any surgical treatment. Here, we show imaging findings and serial image changes of xanthogranulomatous pancreatitis for this case.

Keyword

Xanthogranulomatous pancreatitis; Xanthogranulomatous inflammation; Pancreatitis; Pancreas; Magnetic resonance imaging

MeSH Terms

Adenocarcinoma
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Humans
Inflammation
Magnetic Resonance Imaging*
Middle Aged
Pancreas
Pancreatic Neoplasms*
Pancreatitis*
Tail

Figure

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  Fig. 1 Unenhanced (a), arterial (b), portal (c), and delayed (d) phases of the dynamic computed tomography (CT) image of the pancreas. Primary lesion in the body and tail of the pancreas was not a mass on initial CT image acquired at local medical center, but an expanding suspicious cystic lesion with irregular thick wall (asterisks).

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  Fig. 2 (a) Pre-contrast T1-weighted image demonstrates an ill-defined low signal intensity mass (white arrows) in the body and tail of the pancreas. (b) The mass reveals intermediate high signal intensity (white arrows) on fat-suppressed T2-weighted image. (c) The mass shows low signal intensity (white arrows) with little enhancement on contrast-enhanced T1-weighted image (pancreas parenchymal phase). (d) The mass reveals subtle high signal intensity (white arrow) on high b-value DWI (800 s/mm2).

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  Fig. 3 Microscopic examiantion shows that foamy macrophages (thick arrows) are intermingled with inflammatory cells, and interspersed with multinucleate giant cell (thin arrow), displaying the characteristic appearances of xanthogranulomatous inflammation (H&E stain, × 100).

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  Fig. 4 (a) Two months later, a follow-up CT image displayed that the size of low-density mass (black arrows) in body and tail of the pancreas was decreased at intervals. (b) Six months later, a follow-up CT image showed markedly interval decrease of the mass (black arrows) with hypotrophic change of the pancreas parenchyma.

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