Xanthogranulomatous pancreatitis combined with intraductal papillary mucinous carcinoma in situ

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.

Keywords: Cystic Tumor; Pancreas; Xanthogranulomatous Inflammation.

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).