Xanthogranulomatous pancreatitis: mass lesion of the pancreas simulating pancreatic carcinoma--a report of two cases

Abstract

Xathogranulomatous inflammation is well known in the gall bladder and kidney. Xanthogranulomatous pancreatitis has not been previously described. We report two cases of this new clinicopathologic entity. The first was a 50 years old male with cholelithiasis and progressive obstructive jaundice for 5 months. Radiology was suggestive of carcinoma head of pancreas and a Whipples procedure was performed. The second was a 36 years old male with choledocholithiasis and features of chronic pancreatitis. During pancreaticojejunostomy, a mass was found in the tail of pancreas, which was excised with a suspicion of carcinoma. Gross examination of both specimens showed firm grey white masses, demarcated from the surrounding pancreas but with infiltrative margins, and were thought to be carcinoma. Histopathological examination showed localized inflammation with numerous foamy histiocytes along with dilated ducts and microabscesses. A diagnosis of xanthogranulomatous pancreatitis was made in both instances. In view of clinical, radiological, operative and gross appearances of our cases simulating carcinoma, recognition of xanthogranulomatous chronic pancreatitis as a distinct clinicopathological entity seems important, analogous to similar lesions of the kidney and gall bladder.