PMC5339531_01
Computed tomogram of the abdomen and pelvis with contrast show abnormal fullness in the region of the pancreatic head measuring 4 x 1.5 cm (black arrow) with a dilated pancreatic duct measuring 5 mm.
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Abdominal computed tomogram (CT) with contrast showed an abnormal mass-like fullness of the pancreatic head (measuring 4 x 1.5 x 2 cm) with a dilated pancreatic duct (5 mm) but normal common bile duct (4 mm) (Figure 1).
Magnetic resonance image of the abdomen with contrast (T2 sequence) shows heterogeneous signal pancreatic head mass measuring 4.5 cm, triggering concern for primary pancreatic carcinoma with associated pancreatic duct dilatation and peripancreatic lymphadenopathy (white arrow).
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Magnetic resonance imaging (MRI) of the abdomen was carried out to visualize the biliary ducts; this imaging revealed a 4.5 x 5 cm heterogeneous pancreatic head mass, with pancreatic ductal dilation (1.4 cm) and peripancreatic lymphadenopathy concerning for primary pancreatic malignancy (Figure 2).
(a) Hematoxylin and eosin stain, 20x magnification, cell block, epithelioid, and noncaseating granuloma in a background of blood (white arrow). (b) Pancreatic mass fine needle aspiration, Papanicolaou stain, 20x magnification, and cell block, showing small fragments of epithelioid, noncaseating granuloma (black arrow). (c) Pancreatic mass fine needle aspiration, Papanicolaou stain, 40x magnification, smear showing epithelioid, and noncaseating granuloma (red arrow).
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The pathology revealed noncaseating granulomas with no evidence of malignancy, cellular atypia, or infectious agents such as coccidioidomycosis (Figure 3).