Sarcoidosis of the pancreas mimicking adenocarcinoma

Abstract

Primary sarcoidosis of the pancreas is extremely rare. Clinical presentation is often identical to that of pancreatic adenocarcinoma. Preoperative diagnosis of primary pancreatic sarcoidosis is always challenging. We present a 52-year-old man who developed weight loss and obstructive jaundice. Abdomino-pelvic CT scan showed a mass in the pancreatic head. After hepatopancreaticobiliary MDT discussion, a Whipple's procedure was attempted but the mass was deemed unresectable due to invasion of the superior mesenteric vein. Upon completion of palliative chemotherapy, repeat imaging showed significant mass shrinkage. A reattempt Whipple's procedure was successfully undertaken. Histology showed changes of chronic pancreatitis and peripancreatic granulomatous inflammation with no evidence of malignancy and a diagnosis of sarcoidosis was made. Owing to the devastating nature of pancreatic adenocarcinoma, any mass in the pancreas must be thoroughly investigated before a definitive diagnosis is made.

Figure 1

Abdominal CT scan at presentation, demonstrating mass in pancreatic head.

Figure 2

Medium power histological view of pancreatic resection specimen sample showing severe fibrosis, atrophy of pancreatic parenchyma and duct-centred chronic inflammation, with retention of a normal lobular architecture (H&E). Inset: high-power histological view of small epithelioid non-caseating granulomata within peripancreatic lymph nodes, consistent with sarcoidosis (H&E).