Xanthogranulomatous Pancreatitis Mimicking a Pancreatic Cancer on CT and MRI: a Case Report and Literature Review

Abstract

Xanthogranulomatous inflammation is a rare benign condition involving various organs. However, its pancreas involvement is very rare. To the best of our knowledge, only 17 cases have been described in the literature. Interestingly, all reported 17 cases due to various causes underwent surgical resection. Here, we present a case of xanthogranulomatous pancreatitis in a 63-year-old man. He presented with epigastric pain and solid mass mimicking ductal adenocarcinoma in the body and tail of pancreas on magnetic resonance imaging. The patient was diagnosed as xanthogranulomatous pancreatitis via endoscopic ultrasound-guided fine needle aspiration. After that, he was followed up and monitored without any surgical treatment. Here, we show imaging findings and serial image changes of xanthogranulomatous pancreatitis for this case.

Xanthogranulomatous Pancreatitis Accompanied by Xanthogranulomatous Cholecystitis

“…In later stages, central necrosis or hemorrhage may be absorbed, and solid lesions may be thicker or primary lesions may be replaced by marked proliferative fibrosis intermingled with lipid-laden foamy macrophages and chronic inflammatory cells. The previous cystic lesion disappeared at this stage 20 . The main imaging findings at this point were a lobulated contour and a heterogeneous mass with a hypovascular and progressive enhancement pattern with restricted diffusion, and these imaging findings are almost identical to those of pancreatic cancer 24 .…”

“…The previous cystic lesion disappeared at this stage. 20 The main imaging findings at this point were a lobulated contour and a heterogeneous mass with a hypovascular and progressive enhancement pattern with restricted diffusion, and these imaging findings are almost identical to those of pancreatic cancer. 24 Our case might have been at the later solid stage.…”

“…In total, 56 articles were obtained, of which 17 articles reported the 31 cases of XGP (Table 1). 1,3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] To the best of our knowledge, this is the first report of XGP accompanied with xanthogranulomatous cholecystitis and the fourth case of XGP with IPMN. Xanthogranulomatous inflammation can extend into the adjacent surrounding structure; therefore, there are a lot of reports of XGI directly infiltrating multiple close organs.…”

“…Although imaging findings and differential points of XGP have not been established, some features have been suggested to date. Park et al 20 reported that xanthogranulomatous change occurs in the peripheral wall portion of a pseudocyst or wall-off necrosis in earlier stages, whereas the central cystic portion may be preserved. At this cystic point, XGP is usually visualized as a large (>3 cm) lobulated cystic mass with an irregular thick wall and can be misdiagnosed as SPN, IPMN, and pseudocyst 24 .…”

Xanthogranulomatous pancreatitis combined with multifocal necrosis: A case report and literature review

“…It is difficult to discriminate this condition from pancreatic cancer with clinical and radiologic results [9]. As a result, most cases were overtreated with surgical resection, and there have been only 2 reported cases of conservative management following a nonoperative diagnosis [10,11] . Twenty-one cases had been reported in English literature before 2019.A review of the existing literature was performed ( Table 1).…”