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27 October 2008

Xanthogranulomatous lesion of the pancreas mimicking pancreatic cancer

Yukihiro IsoABCDEF, Nobumi TagayaCDE, Junji KitaDE, Tokihiko SawadaDE, Keiichi KubotaDEG

Med Sci Monit 2008; 14(11): CS130-133 :: ID: 869429

Abstract

Background
Xanthogranulomatous lesion is a rare condition that can develop in the gall bladder, kidney, and retroperitoneal space. This lesion is an inflammatory disease. It is commonly accepted that Xanthogranulomatous lesion of the pancreas (XGP) is hardly distinguishable from pancreatic neoplasms. As a result of the similarity of pancreatic cancer in clinical and imaging diagnostic findings, most of all patients have often been performed excessive surgeries.
Material and Method
An 82-year-old male was admitted to our hospital because of body weight loss. Laboratory tests showed the presence of inflammation, and a Positron emission tomography (PET) revealed positive uptake in the pancreas head and tail, and spleen. Duodeno scopy showed excretion of mucin from the papilla of Vater. Intraductal ultrasonography (IOUS) showed a tumor located at the pancreas tail. Under a preoperative diagnosis of intraductal papillary mucinous carcinoma (IPMC) at the pancreas tail with metastasis to the spleen, distal pancreatectomy and splenectomy were performed. Microscopic findings of the operative specimen revealed massive infiltration of macrophages with fibrosis, the lost of ductal epithelium, and the severe deposition of amyloid and mucin with thrombosis. Pathological diagnosis was XGP. The patient was uneventfully discharged from hospital on the postoperative day 22. Although XGP is a benign condition, most cases are treated by surgery same as our case. This is due to the difficulty in differenciating the lesion from pancreatic cancer.
Results

Conclusions
We reported a rare case of XGP mimicking pancreatic cancer. XGP should be added to one of differential diagnosis of pancreatic cancer.

Keywords: Positron-Emission Tomography, Pancreatic Neoplasms - surgery, Duodenoscopy, Tomography, X-Ray Computed, Diagnosis, Differential, Aged, 80 and over

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