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Eosinophilic Pancreatitis Diagnosed With Endoscopic Ultrasound.

Kakodkar S, Omar H, Cabrera J, Chi K - ACG Case Rep J (2015)

Bottom Line: It usually presents on imaging as a pancreatic mass leading to common bile duct obstruction and jaundice.Since it can mimic a malignancy, eosinophilic pancreatitis is often diagnosed after "false positive" pancreatic resections.After a steroid course, there was improvement of clinical symptoms.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, IL.

ABSTRACT
Eosinophilic pancreatitis (EP) is a rare clinical entity, and few cases have been reported. It usually presents on imaging as a pancreatic mass leading to common bile duct obstruction and jaundice. Since it can mimic a malignancy, eosinophilic pancreatitis is often diagnosed after "false positive" pancreatic resections. To our knowledge, we report the only known case of EP in which the diagnosis was made by fine needle aspiration and core biopsy of the pancreas during EUS, sparing the patient a surgical resection. After a steroid course, there was improvement of clinical symptoms.

No MeSH data available.


Related in: MedlinePlus

ERCP showed a 2-cm distal common bile duct stricture with upstream biliary dilation.
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Figure 5: ERCP showed a 2-cm distal common bile duct stricture with upstream biliary dilation.

Mentions: Abdominal ultrasound showed a hypoechoic lobular mass measuring 6.7 x 4.0 x 3.7 cm in the head of the pancreas, a 10-mm common bile duct, and a distended gallbladder. Contrast abdominal MRI/MRCP showed enlargement of the pancreatic head and uncinate process measuring 5.0 x 4.1 cm and a distended gallbladder (Figure 1). Coronal oblique maximum intensity projection (MIP) image of the biliary system showed occlusion of the common bile duct with tapering within the pancreatic head and occluded pancreatic duct (Figure 2). An endoscopic ultrasound (EUS) demonstrated a diffusely enlarged pancreas, especially in the head and neck, with a normal, non-dilated pancreatic duct measuring 1.6 mm; no focal mass lesion was appreciated (Figure 3). Core biopsy samples of the enlarged pancreatic head obtained using a 19-G EUS needle (Quick-Core, Cook Medical, Bloomington, IN) showed a significant eosinophilic infiltrate (Figure 4). Immunohistochemical stains for IgG and IgG4 were not supportive of autoimmune pancreatitis. There was not enough tissue in the biopsy specimen to perform flow cytometry. ERCP showed a 2-cm distal common bile duct stricture with upstream biliary dilation (Figure 5).


Eosinophilic Pancreatitis Diagnosed With Endoscopic Ultrasound.

Kakodkar S, Omar H, Cabrera J, Chi K - ACG Case Rep J (2015)

ERCP showed a 2-cm distal common bile duct stricture with upstream biliary dilation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508953&req=5

Figure 5: ERCP showed a 2-cm distal common bile duct stricture with upstream biliary dilation.
Mentions: Abdominal ultrasound showed a hypoechoic lobular mass measuring 6.7 x 4.0 x 3.7 cm in the head of the pancreas, a 10-mm common bile duct, and a distended gallbladder. Contrast abdominal MRI/MRCP showed enlargement of the pancreatic head and uncinate process measuring 5.0 x 4.1 cm and a distended gallbladder (Figure 1). Coronal oblique maximum intensity projection (MIP) image of the biliary system showed occlusion of the common bile duct with tapering within the pancreatic head and occluded pancreatic duct (Figure 2). An endoscopic ultrasound (EUS) demonstrated a diffusely enlarged pancreas, especially in the head and neck, with a normal, non-dilated pancreatic duct measuring 1.6 mm; no focal mass lesion was appreciated (Figure 3). Core biopsy samples of the enlarged pancreatic head obtained using a 19-G EUS needle (Quick-Core, Cook Medical, Bloomington, IN) showed a significant eosinophilic infiltrate (Figure 4). Immunohistochemical stains for IgG and IgG4 were not supportive of autoimmune pancreatitis. There was not enough tissue in the biopsy specimen to perform flow cytometry. ERCP showed a 2-cm distal common bile duct stricture with upstream biliary dilation (Figure 5).

Bottom Line: It usually presents on imaging as a pancreatic mass leading to common bile duct obstruction and jaundice.Since it can mimic a malignancy, eosinophilic pancreatitis is often diagnosed after "false positive" pancreatic resections.After a steroid course, there was improvement of clinical symptoms.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, IL.

ABSTRACT
Eosinophilic pancreatitis (EP) is a rare clinical entity, and few cases have been reported. It usually presents on imaging as a pancreatic mass leading to common bile duct obstruction and jaundice. Since it can mimic a malignancy, eosinophilic pancreatitis is often diagnosed after "false positive" pancreatic resections. To our knowledge, we report the only known case of EP in which the diagnosis was made by fine needle aspiration and core biopsy of the pancreas during EUS, sparing the patient a surgical resection. After a steroid course, there was improvement of clinical symptoms.

No MeSH data available.


Related in: MedlinePlus