Korean J Gastroenterol.  2021 Jan;77(1):45-49. 10.4166/kjg.2020.155.

Primary Pancreatic Candidiasis Mimicking Pancreatic Cancer in an Immunocompetent Patient

• Kim CH
• Lee H
• Woo CG
• Han JH
• Choi H
• Park SM

• KMID: 2510776
• DOI: http://doi.org/10.4166/kjg.2020.155

Abstract

Pancreatic candidiasis can develop in patients with acute pancreatitis, compromised immune responses, or iatrogenic intervention. This paper reports a case of pancreatic candidiasis presenting as a solid pancreatic mass in a patient without the risk factors. A previously healthy 37-year-old man visited the emergency department with left flank pain. Abdominal CT revealed a 5 cm, irregular heterogeneous enhancing mass accompanied by a left adrenal mass. Positron emission tomography-computed tomography and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) could not discriminate pancreatic cancer from infectious disease. A laparoscopic exploration was performed for an accurate diagnosis. After distal pancreatectomy with splenectomy and left adrenalectomy, pancreatic candidiasis and adrenal cortical adenoma were diagnosed based on the pathology findings. His condition improved after the treatment with fluconazole. This paper reports a case of primary pancreatic candidiasis mimicking pancreatic cancer in an immunocompetent patient with a review of the relevant literature.

Keyword

Pancreas; Candida; Immunocompetence

Figure

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  Fig. 1 Pancreatic candidiasis in 37-year-old man. (A) Axial computed tomography (CT) scan reveals a 4.5×4.3 cm sized irregular heterogenous enhancing mass (arrow heads) with internal necrosis (asterisk) in the tail of pancreas. A heterogenous enhancing mass was also seen in the left adrenal gland (arrow). (B) Positron emission tomography-CT (PET-CT) shows a hypermetabolic mass at the pancreas tail (SUVmax 10.8, arrow heads) and a low attenuated mass showing minimal uptake at the left adrenal gland (SUVmax 5.0, arrow). (C) Endoscopic ultrasonography (EUS) shows an ill-defined heterogenous hypoechoic mass at the pancreas tail. (D) EUS-guided fine-needle aspiration was performed.

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  Fig. 2 (A) Gross findings of pancreatic mass show that there are necrotic substances in the middle (arrow head), and lobulation of the surrounding pancreatic parenchyma (arrow) is well maintained. (B-D) Microscopic findings. (B) Necrotic substances and severe inflammation can be seen at low magnification (H&E, ×12.5). (C) Most of necrotic substances were neutrophils at medium magnification (H&E, ×100). (D) Hyphae (black arrows) and yeast types (white arrows) were observed at high magnification, consistent with Candida species (PAS staining, ×200).

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  Fig. 3 Changes of WBC count and BT with time and based on treatment. WBC, white blood cell; BT, EUS-FNA, endoscopic ultrasonography-guided fine-needle aspiration.

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