PMC5404617_01
EUS showing a hypoechoic irregular mass in pancreatic head measuring 3.8 x 4.1 cm in maximal cross-sectional diameter.
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F1
An endoscopic ultrasound (EUS) showed an irregular mass (3.8 x 4.1 cm) in the head of the pancreas with abutment to the superior mesenteric artery and superior mesenteric vein (SMV), pancreatic ductal dilation, and atrophy of the remaining pancreas (Figure 1).
CT scan with contrast showing possible pancreatic head mass measuring 2.9 x 3.0 cm.
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F2
Repeat CT showed an ill-defined pancreatic head mass measuring 2.9 x 3 cm (previously measured 2.8 x 3 cm 5 months earlier), with mild decreased pancreatic and biliary ductal dilation, portal vein abutment <180 degrees, and multiple enlarged veins in the peripancreatic mesentery suggestive of SMV occlusion near the confluence (Figure 2).
(A) Hematoxylin and eosin stain at 2x magnification showing the dilated pancreatic duct with inspissated mucus and an adjacent dense inflammatory cell infiltrate (upper left). (B) Gomori methenamine silver stain at 20x magnification showing fungal hyphae (arrow) within the inspissated mucus. (C) Brown-Brenn stain at 40x magnification showing coccoid bacterial organisms (arrow).
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F3
The final histological analysis of the pancreas revealed chronic pancreatitis with pancreatic duct dilation and associated intraluminal inspissisated mucus admixed with fungal and bacterial organisms (Figure 3).