PMC9857271_01
Computed tomography showing a solid 12 mm hypoenhancing mass in the inferior pancreatic head with associated pancreatic ductal dilation (5 mm) and mild hepatic steatosis.
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F1
Abdominal computed tomography with intravenous contrast was subsequently performed demonstrating a solid 12 mm hypoenhancing mass in the inferior pancreatic head with associated pancreatic ductal dilation (5 mm) and mild hepatic steatosis (Figure 1).
Endoscopic ultrasound showing a 15 mm mass in the pancreatic head.
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F2
Endoscopic ultrasound (EUS) showed a 15 mm mass in the pancreatic head, and 4 ultrasound-guided fine-needle biopsies were obtained (Figure 2).
Hematoxylin and eosin stain of pancreatic biopsy at 40x showing marked acute inflammation with areas of necrosis and scant atrophic pancreatic acini (A) and at 200x showing lobulated structures surrounded by inflammatory cells, predominantly polymorphonuclear cells, morphologically consistent with actinomyces infection (B).
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F3
Hematoxylin and eosin stain showed lobulated structures surrounded by inflammatory cells, predominantly polymorphonuclear cells (Figure 3).
Grocott-Gomori methenamine silver stain at x200 of pancreatic biopsy showing the filamentous bacterium while negative for acid-fast bacilli.
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F4
Grocott-Gomori methenamine silver and Gram stains demonstrated a gram-positive, filamentous bacterium (Figure 4).
Computed tomography showing a stable 10 mm hypoenhancing mass of the inferior pancreatic head with persistent pancreatic ductal dilation (6 mm) after 9 months of amoxicillin therapy.
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F5
After 9 months of amoxicillin therapy, interval computed tomography demonstrated a stable 10 mm hypoenhancing mass of the inferior pancreatic head with persistent pancreatic ductal dilation (6 mm) (Figure 5).