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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

MRCP 4 months later showed interval decrease in size of the mass within head of pancreas to 4.2 x 3.3 cm (arrow), with less mass-effect on the descending portion of the duodenum.
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Figure 6: MRCP 4 months later showed interval decrease in size of the mass within head of pancreas to 4.2 x 3.3 cm (arrow), with less mass-effect on the descending portion of the duodenum.

Mentions: The patient underwent biliary sphincterotomy, and cytology brushings of the stricture were consistent with reactive ductal cells and were negative for malignancy. A temporary straight, plastic, 10-French biliary stent was placed across the stricture to allow biliary decompression. The patient had a white blood cell count of 7.7 x 109 cells/L with 0.9 x 109 eosinophils/L (normal: 0.1 to 0.5 x 109 eosinophils/L). The patient's IgE level was 135 U/mL (normal: <100 U/mL). The patient was started on oral steroids for presumed eosinophilic pancreatitis and had complete clinical improvement. MRCP 4 months later showed interval decrease in size of the pancreatic head mass to 4.2 x 3.3 cm with less compression on the descending portion of the duodenum (Figure 6). The gallbladder was no longer distended and the pancreatic duct was normal, suggesting that the common bile duct obstruction had improved. He has since tapered his steroids and had his biliary stent removed with resolution of his symptoms and labs. Esophageal biopsies showed normal esophageal mucosa without an increased amount of eosinophils.


Eosinophilic Pancreatitis Diagnosed With Endoscopic Ultrasound.

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

MRCP 4 months later showed interval decrease in size of the mass within head of pancreas to 4.2 x 3.3 cm (arrow), with less mass-effect on the descending portion of the duodenum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: MRCP 4 months later showed interval decrease in size of the mass within head of pancreas to 4.2 x 3.3 cm (arrow), with less mass-effect on the descending portion of the duodenum.
Mentions: The patient underwent biliary sphincterotomy, and cytology brushings of the stricture were consistent with reactive ductal cells and were negative for malignancy. A temporary straight, plastic, 10-French biliary stent was placed across the stricture to allow biliary decompression. The patient had a white blood cell count of 7.7 x 109 cells/L with 0.9 x 109 eosinophils/L (normal: 0.1 to 0.5 x 109 eosinophils/L). The patient's IgE level was 135 U/mL (normal: <100 U/mL). The patient was started on oral steroids for presumed eosinophilic pancreatitis and had complete clinical improvement. MRCP 4 months later showed interval decrease in size of the pancreatic head mass to 4.2 x 3.3 cm with less compression on the descending portion of the duodenum (Figure 6). The gallbladder was no longer distended and the pancreatic duct was normal, suggesting that the common bile duct obstruction had improved. He has since tapered his steroids and had his biliary stent removed with resolution of his symptoms and labs. Esophageal biopsies showed normal esophageal mucosa without an increased amount of eosinophils.

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