PMC5247627_01
Thickened pancreatic body and tail (circle) and adjacent fat stranding along with retroperitoneal fibrosis surrounding bilateral kidneys and causing hydronephrosis (arrowheads), and periaortitis (arrows).
CG-CGCR160149F001.jpg
PMC5247627_01_CG-CGCR160149F001.jpg
F1
Computed tomography (CT) of the abdomen showed thickening of the pancreatic body and tail and adjacent fat stranding, as well as retroperitoneal fibrosis and periaortitis compressing the middle left renal artery and bilateral urinary collecting systems (Figure 1).
A hypoechoic, focal mass-like lesion (3 x 3 cm) was present at the junction of the pancreatic body and tail (circle).
CG-CGCR160149F002.jpg
PMC5247627_01_CG-CGCR160149F002.jpg
F2
A hypoechoic focal mass-like lesion (3 x 3 cm) was present at the pancreatic body/tail region (Figure 2).
A fork-tip needle was used to perform fine-needle biopsy of the mass.
CG-CGCR160149F003.jpg
PMC5247627_01_CG-CGCR160149F003.jpg
F3
FNB was performed using a SharkCoreTM needle (Figure 3).
(A) Pathology at x10 magnification showed storiform fibrosis in the center (asterisk), marked lymphoplasmacytic infiltration (arrowhead), and a small area of pancreatic acini (arrow). (B) Pathology showed sclerotic tissue with abundant IgG4-positive cells.
CG-CGCR160149F004.jpg
PMC5247627_01_CG-CGCR160149F004.jpg
F4
Pathology showed marked lymphoplasmacytic infiltration with fibrosis and without granulocytic infiltration, storiform fibrosis, and abundant IgG4-positive cells per high-power field (HPF) without evidence of malignancy (Figure 4).