Follicular pancreatitis: A rare pancreatic inflammatory pseudotumor

Abstract

Inflammatory pseudotumors imitate neoplasms on imaging but actually represent focal inflammation. We report a case of follicular pancreatitis, which is a recently recognized distinct form of mass-forming focal chronic pancreatitis pathologically characterized by lymphoid infiltration with abundant reactive germinal centers. In our patient, follicular pancreatitis manifested as a pancreatic tail mass that was resected due to imaging findings, which were suggestive of pancreatic malignancy. We performed a literature review of this rare condition and present a summary of reported imaging findings. The most distinguishing feature from pancreatic adenocarcinoma is the enhancement pattern, as follicular pancreatitis enhances more than the surrounding pancreatic parenchyma on delayed post-contrast images which is unusual for pancreatic adenocarcinoma. If this benign diagnosis is suggested on imaging, unnecessary surgery and its potential complications may be avoided.

Follicular pancreatitis: Case report and literature review

“…Most of the reported cases of follicular pancreatitis have been diagnosed retrospectively after surgical resection, sometimes with surgical complications. [1–7] In our case, EUS-FNB was initially performed for the diagnosis; however, pancreatic cancer was not ruled out. Eventually, a laparoscopic surgical biopsy was performed for an accurate histologic diagnosis.…”

“…The clinical manifestations, diagnosis, treatment, and prognosis of follicular pancreatitis have not been validated yet. [1–7]…”

“…Previous case reports [ 2 ] suggest that follicular pancreatitis typically occurs in patients older than 50 years with a male predominance. The clinical presentation is often asymptomatic, although elevated levels of liver enzymes, abdominal pain, jaundice, malaise, and weight loss have been observed.…”

“…Most reported cases were diagnosed and treated by surgical resection, and there is no recurrence after surgical resection. [1][2][3][4][5][6][7] One case partially responded to steroid therapy [3] ; however, its efficacy remains unclear. Our case was regularly followed without any special treatment.…”

“…Therefore, it is usually diagnosed retrospectively through a surgical approach. [1][2][3][4][5][6][7] Herein, we report a case of a 50-year-old man with follicular pancreatitis, which was mistaken for pancreatic cancer, and the correct diagnosis was made through surgical biopsy, along with a review of the literature about this condition.…”