PMC4009261_01
Initial presentation. Periampullary (pancreatic head) mass and dilated pancreatic duct.
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There was a strong suspicion of pancreatic carcinoma (Figure 1).
(a) and (b) Hematoxylin and eosin stain of the peripancreatic lymph node showing epithelioid granuloma.
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Endoscopic ultrasound- (EUS-) guided fine needle aspiration (FNA) of the pancreatic mass showed reactive atypia with no evidence of malignancy and celiac lymph node FNA cytology showed atypical cells with granuloma (Figures 2(a) and 2(b)).
Six months after initial presentation. Persistent enlargement of peripancreatic lymph nodes and pancreatic duct dilatation.
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CT scan showed increase in the size of lymph nodes and persistent common bile duct and pancreatic duct dilatation (Figure 3).
18 months after initial presentation. (a) CT showing persistent enlarged peripancreatic lymph nodes, pancreatic atrophy, and dilatation of pancreatic duct. (b) Ultrasound abdomen showing enlarged peripancreatic lymph nodes.
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ATT and steroids continued to show enlarged lymph nodes in the porta hepatis, peripancreatic regions, dilated CBD, and pancreatic duct with atrophic looking pancreas (Figures 4(a) and 4(b)). At present, patient is doing well with minimal symptoms and is able to maintain weight.