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Lymphoplasmacytic Sclerosing Pancreatitis with Obstructive Jaundice: CT and Pathology Features

Satomi Kawamoto1, Stanley S. Siegelman1, Ralph H. Hruban2 and Elliot K. Fishman1

1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287.
2 Department of Pathology, Johns Hopkins Hospital, Baltimore, MD.



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  		Fig. 1A. —63-year-old man with lymphoplasmacytic sclerosing pancreatitis and inflammation of common bile duct. Venous phase contrast-enhanced CT scans obtained at level of pancreatic body and tail (A) and pancreatic head (B) show diffuse enlargement of pancreas without discrete mass. Capsulelike rim of decreased attenuation is present around pancreas. Common bile duct stent had been placed. Mild gallbladder wall thickening and contrast enhancement are seen, but pathologically no evidence of inflammation is present.

 


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  		Fig. 1B. —63-year-old man with lymphoplasmacytic sclerosing pancreatitis and inflammation of common bile duct. Venous phase contrast-enhanced CT scans obtained at level of pancreatic body and tail (A) and pancreatic head (B) show diffuse enlargement of pancreas without discrete mass. Capsulelike rim of decreased attenuation is present around pancreas. Common bile duct stent had been placed. Mild gallbladder wall thickening and contrast enhancement are seen, but pathologically no evidence of inflammation is present.

 


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  		Fig. 1C. —63-year-old man with lymphoplasmacytic sclerosing pancreatitis and inflammation of common bile duct. Endoscopic retrograde cholangiogram shows long, smooth stricture in mid and lower common bile duct with dilatation above stricture. Scattered focal stenoses were also seen in right hepatic ducts.

 


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  		Fig. 2A. —51-year-old man with lymphoplasmacytic sclerosing pancreatitis (LPSP) and inflammation of common bile duct and gallbladder. Arterial (A) and venous (B) phase contrast-enhanced CT scans at level of pancreatic body and tail show diffuse enlargement of pancreas. Capsulelike low-attenuation rim is seen around pancreas. No pancreatic duct dilatation is observed. Thickening and contrast enhancement of gallbladder and common bile duct are present. Common bile duct is dilated above intrapancreatic portion. Gallstone is partially visualized on arterial phase image.

 


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  		Fig. 2B. —51-year-old man with lymphoplasmacytic sclerosing pancreatitis (LPSP) and inflammation of common bile duct and gallbladder. Arterial (A) and venous (B) phase contrast-enhanced CT scans at level of pancreatic body and tail show diffuse enlargement of pancreas. Capsulelike low-attenuation rim is seen around pancreas. No pancreatic duct dilatation is observed. Thickening and contrast enhancement of gallbladder and common bile duct are present. Common bile duct is dilated above intrapancreatic portion. Gallstone is partially visualized on arterial phase image.

 


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  		Fig. 2C. —51-year-old man with lymphoplasmacytic sclerosing pancreatitis (LPSP) and inflammation of common bile duct and gallbladder. Venous phase CT scan obtained at level of main portal vein shows circumferential thickening and contrast enhancement of common bile duct (large arrow). Small lymph nodes are also seen in porta hepatis (small arrows).

 


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  		Fig. 2D. —51-year-old man with lymphoplasmacytic sclerosing pancreatitis (LPSP) and inflammation of common bile duct and gallbladder. Anterior volume-rendered 3D reconstruction of CT image shows diffusely enlarged pancreas, particularly in head. Stenosis of intrapancreatic portion and dilatation of more superior portion of common bile duct are seen. Thickening and contrast enhancement of dilated common bile duct were seen above pancreas (arrow). Increased thickness and contrast enhancement of gallbladder are seen. Pathologically, dense mixed infiltrates and fibrosis in common bile duct and gallbladder are also present.

 


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  		Fig. 2E. —51-year-old man with lymphoplasmacytic sclerosing pancreatitis (LPSP) and inflammation of common bile duct and gallbladder. Photomicrograph of surgical specimen of pancreas shows classic changes of LPSP involvement of pancreatic duct. Dense inflammatory infiltrates with associated fibrosis surrounds pancreatic duct. (H and E, x40)

 


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  		Fig. 2F. —51-year-old man with lymphoplasmacytic sclerosing pancreatitis (LPSP) and inflammation of common bile duct and gallbladder. Photomicrograph of surgical specimen shows common bile duct with dense mixed infiltrate and fibrosis. (H and E, x64)

 


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  		Fig. 3A. —63-year-old man with lymphoplasmacytic sclerosing pancreatitis and inflammation of common bile duct and gallbladder. Venous phase contrast-enhanced CT scans obtained at level of pancreatic head and body (A) and pancreatic head (B) show enlargement of head of pancreas without discrete mass. Pancreatic duct is not dilated. Common bile duct stent is in place. Subcapsular hematoma is seen along liver surface. Contrast material residue is seen in gallbladder lumen.

 


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  		Fig. 3B. —63-year-old man with lymphoplasmacytic sclerosing pancreatitis and inflammation of common bile duct and gallbladder. Venous phase contrast-enhanced CT scans obtained at level of pancreatic head and body (A) and pancreatic head (B) show enlargement of head of pancreas without discrete mass. Pancreatic duct is not dilated. Common bile duct stent is in place. Subcapsular hematoma is seen along liver surface. Contrast material residue is seen in gallbladder lumen.

 


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  		Fig. 3C. —63-year-old man with lymphoplasmacytic sclerosing pancreatitis and inflammation of common bile duct and gallbladder. Venous phase CT scan obtained at level of main portal vein shows circumferential thickening of common bile duct with increased contrast enhancement (arrow). Pathologically, common bile duct showed extensive fibrosis and lymphoplasmacytic infiltrate.

 

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