LETTERS TO THE EDITOR

 

Xanthogranulomatous pancreatitis: a lesion that mimics pancreatic cancer

Pancreatitis xantogranulomatosa: una lesión que simula una neoplasia de páncreas

 

 

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Key words: Xanthogranulomatosis. Pancreatitis. Pancreatic mass.

Palabras clave: Xantogranulomatosis. Pancreatitis. Masa pancreática.

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Dear Editor,

Xanthogranulomatous pancreatitis (XGP) is an extremely rare entity. In most cases, XGP is preoperatively misdiagnosed as a pancreatic neoplasm. The pathogenesis is not well established (1). To our knowledge, only 15 cases have been reported in the English language literature. Surgical resection was performed before the histologic diagnosis in all published cases. We report the first case of XGP described in Spain, diagnosed by CT-guided biopsy, without requiring surgical resection, in a patient initially diagnosed as having a pancreatic neoplasm.

 

Case report

An 80-year old woman was admitted to our hospital with a long evolution of epigastric pain and weight loss, without a previous history of infections or pancreatic diseases. Laboratory tests: bilirubin 0.7 mg/dl, amylase 80 u/l, C-reactive protein 6.7 mg/l, transaminases and tumor markers were normal. A computed tomography (CT) scan revealed a mass in the pancreatic head suggestive of adenocarcinoma. The endoscopic ultrasonography (sectorial) showed an inconclusive heterogeneous area in the pancreatic head. Fine needle aspiration (two passes, by a cytologist) showed no malignant cells. A positron emission tomography-CT scan was performed and showed a hypermetabolic nodule suggestive of malignancy. On the basis of the possible diagnosis of a malignant neoplasm of the pancreas in an elderly patient, a guided-CT biopsy (Tru-Cut) of the lesion was performed and showed an XGP. A conservative approach was taken. At the 6-month visit, no changes in the CT were found.

 

 

Discussion

The pathogenesis of the XGP is not well understood. The XGP is a benign entity and occurs mainly in male patients with a mean age of 56 years. The most common symptom is abdominal pain. The initial diagnosis in most reported cases is pancreatic malignancy, and in all cases surgical resection (2-5) has been performed. Although XGP is a very rare entity, it is important to recognize this uncommon entity in the differential diagnosis of pancreatic tumors.

 

Belén Navarro, Esteban Sáez-González and Juan Ortuño
Gastroenterology Unit. Department of Digestive Medicine.
Hospital Universitari i Politècnic La Fe. Valencia, Spain

 

References

1. Houston JP, Collins MC, Cameron I, et al. Xanthogranulomatous cholecystitis. Br J Surg 1994;81:1030-2. DOI: 10.1002/bjs.1800810735.         [ Links ]

2. Iver 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;47:36-8.         [ Links ]

3. Okabayashi T, Nishimori I, Kobayashi M, et al. Xanthogranulomatous pancreatic abscess secondary to acute pancreatitis: Two case reports. Hepatogastroenterol 2007;54:1648-51.         [ Links ]

4. Iso Y, Tagaya N, Kita J, et al. Xanthogranulomatous lesion of the pancreas mimicking pancreatic cáncer. Med Sci Monit 2008;14:CS130-3.         [ Links ]

5. Kang BW, Kim JW, Jo JC, et al. A case of xanthogranulomatous pancreatitis. Korean J Med 2007;72(Suppl 2):S171-4.         [ Links ]