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A case of progressive xanthogranulomatous pancreatitis with splenic abscess

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Abstract

Xanthogranulomatous inflammation is a chronic inflammatory reaction microscopically characterized by aggregation of foamy histiocytes, fibrous tissue, and infiltration of various inflammatory cells. In contrast to xanthogranulomatous inflammation in the gallbladder or kidney, xanthogranulomatous pancreatitis is rare. We herein present a case of xanthogranulomatous pancreatitis in a patient who underwent distal pancreatectomy with splenectomy under preoperative suspicion of a pancreatic pseudocyst or pancreatic tumor. A 77-year-old woman with a 1 month history of epigastric pain, anorexia, and general fatigue was admitted to our hospital. Contrast-enhanced computed tomography revealed a cystic mass with ill-defined margins at the pancreatic tail together with a splenic abscess. Contrast-enhanced endoscopic ultrasound detected a hyperechoic cystic lesion at the tail of the pancreas with heterogeneous internal echogenicity, and part of the intra-cystic content was enhanced by the contrast agent. Endoscopic retrograde cholangiopancreatography showed a cystic lesion at the tail of the pancreas that continued into the main pancreatic duct, and the main pancreatic duct was slightly narrowed downstream of the cystic lesion. Pancreatic juice cytology revealed suspicious cells, leading to the possibility of intraductal papillary mucinous carcinoma. Distal pancreatectomy with splenectomy was performed, and the histopathological diagnosis was xanthogranulomatous pancreatitis with no malignant findings.

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Acknowledgements

This study was supported by a Grant-in-Aid for Research Activity Start-up (19K24012) and a Grant-in-Aid for Scientific Research C (22K08749) (to K.N.) from the Ministry of Education, Culture, Science and Sports, Japan. The authors thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan

    Keiji Nagata, Kojiro Nakamura, Taku Iida, Junji Iwasaki, Toshiyuki Hata, Atsushi Itami & Takahisa Kyogoku

  2. Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan

    Kojiro Nakamura

  3. Department of Gastroenterology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan

    Ryo Ito

  4. Department of Diagnostic Pathology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan

    Satsuki Asai & Misa Ishihara

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  1. Keiji Nagata
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  2. Kojiro Nakamura
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  3. Taku Iida
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  9. Atsushi Itami
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  10. Takahisa Kyogoku
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Correspondence to Kojiro Nakamura.

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Keiji Nagata, Kojiro Nakamura, Taku Iida, Junji Iwasaki, Ryo Ito, Satsuki Asai, Misa Ishihara, Toshiyuki Hata, Atsushi Itami, and Takahisa Kyogoku declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

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Informed consent was obtained from the patient described in this report.

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Nagata, K., Nakamura, K., Iida, T. et al. A case of progressive xanthogranulomatous pancreatitis with splenic abscess. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01930-1

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