PMC3134062_01
CT scan. This examination was carried out after a double bypass biliary-enteric and gastro-enteric bypass for jaundice and unresectable head pancreatic mass and it shows a pancreatic mass (arrow) without dilation of the Wirsung duct.
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F1
A CT scan carried out in the postoperative period confirmed the pancreatic mass without dilation of the Wirsung duct (fig. 1); cytology of the pancreatic mass was carried out and no malignant cells were detected.
Ultrasound-guided fine needle pancreatic biopsy (July 2010). The pathological examination reveals lymphoplasmacytic infiltrate (asterisks) (a) and granulocytic epithelial lesions (arrow) (b).
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F2
He underwent ultrasound-guided fine needle biopsy which disclosed chronic pancreatitis with lymphoplasmacytic infiltrate, a low number of eosinophils and intralobular and interlobular fibrosis, associated with granulocytic epithelial lesions and panIN 1A-B (fig. 2) suggestive of a diagnosis of AIP.
18 FDG-PET. a CT image (CT coronals). b Positron emission tomography acquisition (PET coronals) shows a markedly increased glucose uptake in the mass of the pancreas head (SUV 6.1) (arrow). c Fusion image of CT and PET (fused coronals); the arrow indicates the pancreatic head mass.
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F3
Moreover, 18-fluorodeoxyglucose positron emission tomography (18 FDG-PET) showed a markedly increased glucose uptake in the head of the pancreas (SUV 6.1) and was unremarkable for differentiating pancreatic cancer from AIP (fig. 3).
CT scan carried out in October 2010. This examination shows the pancreatic mass (asterisk) and the dilation of the main pancreatic duct behind the lesion (arrows).
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F4
Another CT scan was carried out in October 2010, and this examination showed that the pancreatic mass had increased in volume (6 x 5.7 cm) and the main pancreatic duct was dilated behind the solid mass (fig. 4).
Ultrasound-guided fine needle pancreatic biopsy (October 2010). The pathological examination shows the presence of a poor periductal lymphoplasmacytic infiltrate (white asterisk) and marked fibrosis (black asterisk) and the presence of both intraductal papillary mucinous neoplasia (black arrow) and ductal adenocarcinoma (white arrows).
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F5
The patient underwent another ultrasound-guided fine needle biopsy which showed the presence of intense fibrosis due to immunosuppressive therapy, the presence of a poor lymphoplasmacytic infiltrate and an intraductal papillary mucinous tumor; a ductal adenocarcinoma was also found (fig. 5).