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      Xanthogranulomatous Pancreatitis Presents as a Solid Tumor Mass: A Case Report

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          Abstract

          Xanthogranulomatous inflammation (XGI) is a rare, idiopathic process in which lipid-laden histiocytes are deposited at various locations in the body. Although XGI has been reported to occur in various organs such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, urachus, and urinary bladder and in soft tissues, xanthogranulomatous pancreatitis (XGP) is extremely rare. Herein, we report a case of XGP occurring in a 70-yr-old woman, who presented with abdominal pain for several months. On physical examination, mild epigastric tenderness was noted. Abdomen CT scan revealed a low attenuated mass in uncinate process of pancreas, suggesting malignant lesion. Whipple's operation was performed and the final pathologic diagnosis was XGP. The patient's post-operative course was uneventful, and no recurrence was found within 7 months of the operation. When a pancreatic mass does not show clinico-radiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis.

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          Most cited references16

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          Xanthogranulomatous cholecystitis.

          Clinical, radiological and pathological findings in 31 patients with xanthogranulomatous cholecystitis have been reviewed. The spectrum of presentation was similar to that of cholelithiasis but fewer patients had biliary colic (17 per cent) and there were more complications (32 per cent). Four patients had a biliary fistula and four a perforated gallbladder with abscess formation. Patients characteristically had gallstones. Appearances often mimicked carcinoma of the gallbladder at ultrasonography and/or laparotomy, with xanthogranulomatous tissue extending to adjacent structures. Xanthogranulomatous cholecystitis and carcinoma of the gallbladder coexisted in three patients. The possibility should be considered that an 'inoperable tumour' of the gallbladder may in fact be xanthogranulomatous cholecystitis, a benign condition that frozen-section biopsy may confirm.
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            Xanthogranulomatous pancreatitis associated with intraductal papillary mucinous tumor.

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              Xanthogranulomatous lesion of the pancreas mimicking pancreatic cancer.

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

                Author and article information

                Journal
                J Korean Med Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                April 2011
                28 March 2011
                : 26
                : 4
                : 583-586
                Affiliations
                [1 ]Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea.
                [2 ]Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
                [3 ]Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Korea.
                [4 ]Department of General Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
                Author notes
                Address for Correspondence: Han-Seong Kim, MD. Department of Pathology, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea. Tel: +82.31-910-7142, Fax: +82.31-910-7139, hskim@ 123456paik.ac.kr
                Article
                10.3346/jkms.2011.26.4.583
                3069582
                21468270
                811d9c9b-637f-4bfb-9a0f-e77aca80390c
                © 2011 The Korean Academy of Medical Sciences.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 September 2010
                : 14 December 2010
                Categories
                Case Report
                Gastroenterology & Hepatology

                Medicine
                pancreatitis,neoplasms,inflammation,xanthogranulomatous
                Medicine
                pancreatitis, neoplasms, inflammation, xanthogranulomatous

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