J Korean Med Sci.  2010 Dec;25(12):1814-1817. 10.3346/jkms.2010.25.12.1814.

Xanthogranulomatous Pancreatitis Combined with Intraductal Papillary Mucinous Carcinoma In Situ

• Kim YN
• Park SY
• Kim YK
• Moon WS

• KMID: 1792910
• DOI: http://doi.org/10.3346/jkms.2010.25.12.1814

Abstract

Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.

Keyword

Pancreas; Xanthogranulomatous Inflammation; Cystic Tumor

MeSH Terms

Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery
Aged
Carcinoma in Situ/*diagnosis/pathology/surgery
Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery
Carcinoma, Papillary/*diagnosis/pathology/surgery
Diagnosis, Differential
Female
Granuloma/complications/*diagnosis
Humans
Magnetic Resonance Imaging
Pancreatic Neoplasms/*diagnosis/pathology/surgery
Pancreaticoduodenectomy
Pancreatitis/complications/*diagnosis
Tomography, X-Ray Computed
Xanthomatosis/complications/*diagnosis

Figure

• 

  Fig. 1 Images of the pancreatic lesions. (A) The coronal single-projection thick-section rapid acquisition with relaxation enhancement MR cholangiography showed a tortuously dilated main pancreatic duct with adjacent variable sized multiple cysts (arrows). (B) An axial, pancreatic phase, three-dimensional MRI after the administration of gadopentetate dimeglumine showed an area of ill-defined, focally decreased signal intensity in the pancreatic neck portion (arrows).

• 

  Fig. 2 Pathologic findings of the pancreatic lesions. (A) Macroscopically, the pancreatic main duct was dilated, and variable sized-mucin containing cysts and parenchymal yellow nodular lesions were observed (arrows). (B) Microscopically, dilated ducts that were epithelized by papillary and micropapillary columnar mucous cells with severe dysplastic change were seen (H&E, ×200). (C) The surrounding pancreatic tissue was atrophic and infiltrated with many foamy macrophages, lymphocytes and plasma cells (H&E, ×100). (D) Positive CD 68 immunohistochemical staining of the foam cells (×200).

Reference

1. Iso Y, Tagaya N, Kita J, Sawada T, Kubota K. Xanthogranulomatous lesion of the pancreas mimicking pancreatic cancer. Med Sci Monit. 2008. 14:CS130–CS133.

2. Kamitani T, Nishimiya M, Takahashi N, Shida Y, Hasuo K, Koizuka H. Xanthogranulomatous pancreatitis associated with intraductal papillary mucinous tumor. AJR Am J Roentgenol. 2005. 185:704–707.

3. Guzmán-Valdivia G. Xanthogranulomatous cholecystitis: 15 years' experience. World J Surg. 2004. 28:254–257.

4. Eastham J, Ahlering T, Skinner E. Xanthogranulomatous pyelonephritis: clinical findings and surgical considerations. Urology. 1994. 43:295–299.

5. Shima Y, Saisaka Y, Furukita Y, Nishimura T, Horimi T, Nakamura T, Tanaka K, Shibuya Y, Ozaki K, Fukui Y, Hamada M, Nishioka Y, Okabayashi T, Taniki T, Morita S, Iwata J. Resected xanthogranulomatous pancreatitis. J Hepatobiliary Pancreat Surg. 2008. 15:240–242.

6. Iyer VK, Aggarwal S, Mathur M. Xanthogranulomatous pancreatitis: mass lesion of the pancreas simulating pancreatic carcinoma-a report of two cases. Indian J Pathol Microbiol. 2004. 47:36–38.