Skip to main content
SpringerLink
Log in

Imaging and clinical features of xanthogranulomatous pancreatitis: an analysis of 10 cases at a single institution

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to investigate the imaging and clinical features of xanthogranulomatous pancreatitis (XGP).

Methods

This retrospective series study included 10 patients with pathology-proven XGP. Two radiologists reviewed the computed tomography (CT) and magnetic resonance imaging (MRI) in consensus to determine the morphological features of XGP. The lesion enhancement pattern on dynamic contrast-enhanced scans and the MR signal intensity were also evaluated. Clinical data including symptoms, underlying pancreatic disease, and laboratory findings were reviewed.

Results

Two XGP cases were of a solid type; six were of cystic type, and two were mixed type. XGP usually showed a lobulated contour (90%) and heterogeneous enhancement (100%), with lesion size varying from 2 to 11 cm. Perilesional infiltration was common (90%), but pancreatic duct dilatation was less frequent (30%). Cystic type XGP mostly had an irregular thick wall (83%). On dynamic contrast-enhanced CT/MRI, XGP enhanced progressively from arterial to portal or delayed phases. Lesions appeared hypointense on T1-weighted images (89%) and hyperintense on T2-weighted images (100%). All lesions appeared hyperintense on diffusion-weighted images, with the majority (78%) showing diffusion restriction on apparent diffusion coefficient maps. The patients often had abdominal pain (80%) and underlying pancreatic disease (80%), but mostly had normal or clinically insignificant laboratory findings.

Conclusions

XGP typically manifests as a clinically silent lobulated heterogeneous mass, with a progressive enhancement pattern and/or irregular thick wall, and diffusion restriction on CT/MRI. Awareness of the imaging and clinical features of XGP may help differentiate it from pancreatic neoplasms, thereby reducing unnecessary surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Craig WD, Wagner BJ, Travis MD (2008) Pyelonephritis: radiologic-pathologic review. Radiographics 28:255–276

    Article  Google Scholar 

  2. Levy AD, Murakata LA, Abbott RM, Rohrmann CA Jr (2002) From the archives of the AFIP: benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation. Radiographics 22:387–413

    Article  Google Scholar 

  3. Cozzutto C, Carbone A (1988) The xanthogranulomatous process: xanthogranulomatous inflammation. Pathol Res Pract 183:395–402

    Article  CAS  Google Scholar 

  4. Atreyapurapu V, Keshwani A, Lingadakai R, Pai K (2016) Xanthogranulomatous pancreatitis mimicking a malignant solid tumour. BMJ Case Rep 2016:bcr2015209934

  5. Becker-Weidman D, Floré B, Mortelé K (2017) Xanthogranulomatous pancreatitis: a review of the imaging characteristics of this rare and often misdiagnosed lesion of the pancreas. Clin Imaging 45:12–17

    Article  Google Scholar 

  6. Hanna T, Abdul-Rahman Z, Greenhalf W, et al. (2016) Xanthogranulomatous pancreatitis associated with a mucinous cystic neoplam. Pathol Int 66:174–176

    Article  Google Scholar 

  7. Iso Y, Tagaya N, Kita J, et al. (2008) Xanthogranulomatous lesion of the pancreas mimicking pancreatic cancer. Med Sci Monit 14:CS130–CS133

    PubMed  Google Scholar 

  8. Iyer VK, Aggarwal S, Mathur M (2004) Xanthogranulomatous pancreatitis: mass lesion of the pancreas simulating pancreatic carcinoma: a report of two cases. Indian J Pathol Microbiol 47:36–38

    PubMed  Google Scholar 

  9. Kamitani T, Nishimiya M, Takahashi N, et al. (2005) Xanthogranulomatous pancreatitis associated with intraductal papillary mucinous tumor. AJR Am J Roentgenol 185:704–707

    Article  Google Scholar 

  10. Kim H-S, Joo M, Chang SH, et al. (2011) Xanthogranulomatous pancreatitis presents as a solid tumor mass: a case report. J Korean Med Sci 26:583–586

    Article  Google Scholar 

  11. Kim YN, Park SY, Kim YK, Moon WS (2010) Xanthogranulomatous pancreatitis combined with intraductal papillary mucinous carcinoma in situ. J Korean Med Sci 25:1814–1817

    Article  Google Scholar 

  12. Nishimura M, Nishihira T, Hirose T, et al. (2011) Xanthogranulomatous pancreatitis mimicking a malignant cystic tumor of the pancreas: report of a case. Surg Today 41:1310–1313

    Article  Google Scholar 

  13. Okabayashi T, Nishimori I, Kobayashi M, et al. (2007) Xanthogranulomatous pancreatic abscess secondary to acute pancreatitis: two case reports. Hepatogastroenterology 54:1648–1651

    PubMed  Google Scholar 

  14. Shima Y, Saisaka Y, Furukita Y, et al. (2008) Resected xanthogranulomatous pancreatitis. J Hepatobiliary Pancreat Surg 15:240–242

    Article  Google Scholar 

  15. Uguz A, Yakan S, Gurcu B, et al. (2010) Xanthogranulomatous pancreatitis treated by duodenum-preserving pancreatic head resection. Hepatobiliary Pancreat Dis Int 9:216–218

    PubMed  Google Scholar 

  16. Park JM, Cho SH, Bae H-I, et al. (2016) Xanthogranulomatous pancreatitis mimicking a pancreatic cancer on CT and MRI: a case report and literature review. Investig Magn Reson Imaging 20:185–190

    Article  Google Scholar 

  17. Tanaka M, Fernandez-del Castillo C, Adsay V, et al. (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197

    Article  Google Scholar 

  18. Fatima Z, Ichikawa T, Motosugi U, et al. (2011) Magnetic resonance diffusion-weighted imaging in the characterization of pancreatic mucinous cystic lesions. Clin Radiol 66:108–111

    Article  CAS  Google Scholar 

  19. Sandrasegaran K, Akisik FM, Patel AA, et al. (2011) Diffusion-weighted imaging in characterization of cystic pancreatic lesions. Clin Radiol 66:808–814

    Article  CAS  Google Scholar 

  20. Yoon MA, Lee JM, Kim SH, et al. (2009) MRI features of pancreatic colloid carcinoma. AJR Am J Roentgenol 193:W308–W313

    Article  Google Scholar 

  21. Baek JH, Lee JM, Kim SH, et al. (2010) Small (< or = 3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT. Radiology 257:97–106

    Article  Google Scholar 

  22. Jang KM, Kim SH, Kim YK, et al. (2012) Imaging features of small (<=3 cm) pancreatic solid tumors on gadoxetic-acid-enhanced MR imaging and diffusion-weighted imaging: an initial experience. Magn Reson Imaging 30:916–925

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea

    Ji Hye Kwon, Jin Hee Kim, So Yeon Kim, Jae Ho Byun, Hyoung Jung Kim, Moon-Gyu Lee & Seung Soo Lee

  2. Department of Diagnostic Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea

    Seung-Mo Hong

Authors
  1. Ji Hye Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Hee Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. So Yeon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae Ho Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyoung Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seung-Mo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Moon-Gyu Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seung Soo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Hee Kim.

Ethics declarations

Funding

No funding was received for the performance of this study.

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Requirement for informed consent was waived by our institutional review board for this retrospective study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwon, J.H., Kim, J.H., Kim, S.Y. et al. Imaging and clinical features of xanthogranulomatous pancreatitis: an analysis of 10 cases at a single institution. Abdom Radiol 43, 3349–3356 (2018). https://doi.org/10.1007/s00261-018-1630-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-018-1630-0

Keywords

Search

Navigation