A Resected Case of Tumor-Forming Pancreatitis with Severe Granuloma Differentiated from Pancreatic Cancer with Difficulty

Suguru Yamada, Naohito Kanazumi, Tsutomu Fujii, Shin Takeda, Shuji Nomoto, Hiroyuki Sugimoto, Yoshie Shimoyama* and Akimasa Nakao

Department of Surgery II, Graduate School and Faculty of Medicine, University of Nagoya
Department of Pathology, Nagoya University Hospital*

A 60-year-old man seen elsewhere for nausea and upper abdominal pain and admitted for obstructive jaundice based on laboratory data was found in abdominal computed tomography (CT) to have two tumors in the head and tail of the pancreas, which were not enhanced. Abdominal angiography showed that the tumors involved the splenic artery and vein. We operated based on a preoperative diagnosis of pancreatic double cancer. A few granulomatous nodules, not diagnosed as peritoneal dissemination, were seen on the mesentery of the small intestine, and the total pancreas was sclerosed by tumors, which invaded the superior mesenteric vein, necessitating total pancreatectomy with superior mesenteric vein resection. Postoperative pathological findings showed that epithelioid granulomas with multinucleated giant cells had formed in the pancreas, yielding a diagnosis of granulomatous pancreatitis. We conducted further examinations to rule out other granulomatous diseases, making a definitive diagnosis of tumor-forming pancreatitis with severe granuloma. No such case has, to our knowledge been reported in Japan.

Key words
tumor-forming pancreatitis, granuloma, pancreatic cancer

Reprint requests
Suguru Yamada Department of Surgery II, Graduate School and Faculty of Medicine, Nagoya University
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
October 25, 2006

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