A Case of Pancreatic Mass Induced by Pancreatic Anisakiasis

Kei Horino, Masami Kimura, Takumasa Nishimura, Hiroo Matsushita, Mitsuhiro Inoue, Yutaka Tsuruta, Kosei Kawata and Kenji Hiromatsu*

Department of Surgery, Health Insurance Hitoyoshi General Hospital
Department of Parasitology, Miyazaki Medical College*

A 53-year-old man was admitted for right hypochondralgia, and CT and MRI revealed a mass 3 cm in diameter in the head of the pancreas and enlarged lymph nodes around the celiac trunk. Magnetic resonance cholangiopancreatography (MRCP) showed common bile duct stenosis in the head of the pancreas. Tumor marker levels were within normal limits (CEA, CA19-9). We performed pylorus-preserving pancreatoduodenectomy with regional lymph node dissection, because of strong suspicion of pancreatic cancer. Microscopic examination of the resected specimen showed a granuloma with eosinophlic infiltration, which was highly suspicious of infiltration by parasites, but we were unable to identify any cancer cells or worms in the mass. A serodiagnostic assay by microenzyme-linked immunosorbent assay using monoclonal antibodies specific for Anisakis antigens led to a diagnosis of pancreatic anisakiasis. The postoperative course was favorable, and the patient was discharged 38 days after surgery. Only four cases of pancreatic anisakiasis, including our own, have ever been reported.

Key words
pancreatic tumor, anisakiasis, granuloma

Reprint requests
Kei Horino Department of Surgery, Health Insurance Hitoyoshi General Hospital
35 Oigami, Hitoyoshi, 868-8555 JAPAN

Accepted
July 26, 2006

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