Xanthogranulomatous Pancreatitis Accompanied by Xanthogranulomatous Cholecystitis

Abstract

Xanthogranulomatous pancreatitis (XGP) is extremely rare, with only 31 cases reported in the English literature to date. We reviewed previously reported 17 articles about XGP and report an additional case of XGP. This is the first case of XGP with xanthogranulomatous cholecystitis accompanied by intraductal papillary mucinous carcinoma (IPMC) in an 80-year-old woman. She was referred to our hospital with jaundice and general malaise and was found to have a cystic mass at the pancreatic head and a solid mass at the pancreatic tail, with dilation of both the main pancreatic duct and biliary tract noted on computed tomography. Diagnosis of IPMC at the pancreatic head with neuroendocrine tumor at the pancreatic tail was made, and the patient underwent subtotal stomach-preserving pancreatoduodenectomy with enucleation of the mass at the tail. Pathological examination revealed IPMC with xanthogranulomatous changes around the IPMC and at the pancreatic tail and gallbladder. Xanthogranulomatous pancreatitis could be induced by inflammatory reaction due to obstruction of the pancreatic duct and biliary tract by mucin produced in the IPMC. It is sometimes difficult to preoperatively differentiate XGP from malignant pancreatic tumors, such as pancreatic carcinoma or neuroendocrine tumor, using imaging studies.

Xanthogranulomatous inflammation involving the gallbladder, bile duct, and pancreas: a case report

“…The pathogenesis underlying this condition remains unclear given the limited number of reported cases. The limited existing literature suggest that high intraluminal pressure and infection seem to be the etiology of the XGI series of disorders ( 3 , 5 ). In the present case, it may be that XGCc occurred first because XGCc is more common and then inflammatory cells infiltrated into surrounding tissues along the biliary tract.…”

“…XGI rarely infiltrates the pancreas and bile ducts. Only 34 cases of xanthogranulomatous pancreatitis (XGP) ( 3 ) ( Table 1 ) and 15 cases of xanthogranulomatous cholangitis (XGCg) ( 4 ) ( Table 2 ) have been reported in the English language literature (supplementary). To our knowledge, we report the first case of XGI with the simultaneous involvement of the gallbladder, bile duct, and pancreas.…”

Xanthogranulomatous cholecystitis

“…Microabcesele tind să se formeze, de asemenea, în peretele vezicii biliare și astfel provoacă o reacție fibroasă și cicatrice rezultă din vindecarea reacției inflamatorii [4,23]. Ruptura mucoasei seroase a vezicii biliare și răspândirea răspunsului inflamator duce la aderențe cu ficatul, stomacul, duodenul și colonul transvers, pancreas [4, 24,25,31], provocând perforații, aderențe, abcese, colangite, pancreatite și formarea fistulilor cu un intestin adiacent [8]. Deseori îngroșarea remarcabilă a peretelui vezicii biliare și aderențele dense din apropiere pot fi ușor confundate cu carcinomul vezicii biliare [4,8].…”