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Xanthogranulomatous Pancreatitis Associated with Intraductal Papillary Mucinous Tumor

Takeshi Kamitani1, Masaki Nishimiya1, Naoki Takahashi2, Yoshitaka Shida1, Kanehiro Hasuo1 and Hitohiko Koizuka3

1 Department of Radiology, International Medical Center of Japan, Shinjuku-ku, Tokyo, Japan.
2 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
3 Department of Gastroenterology, International Medical Center of Japan, Shinjuku-ku, Tokyo, Japan.



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  		Fig. 1A —82-year-old man with xanthogranulomatous pancreatitis. Delayed-phase contrast-enhanced CT image shows 3-cm cystic mass (long arrow) and many small cystic lesions (short arrow) in pancreas body. Ill-defined enhancing area is seen around these cystic lesions. Main pancreatic duct in tail region is dilated and splenic vein is compressed.

 


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  		Fig. 1B —82-year-old man with xanthogranulomatous pancreatitis. T2-weighted image shows cystic masses (long and short arrows). Contents of these cysts appear hyperintense, but appear to be of somewhat lower intensity than that of a simple cyst.

 


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  		Fig. 1C —82-year-old man with xanthogranulomatous pancreatitis. T1-weighted MR images with fat saturation show cystic mass and surrounding enhancing area (long arrow, C). Border between mass and gastric wall is unclear, and enhancing area extends into gastric wall (arrowheads, D).

 


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  		Fig. 1D —82-year-old man with xanthogranulomatous pancreatitis. T1-weighted MR images with fat saturation show cystic mass and surrounding enhancing area (long arrow, C). Border between mass and gastric wall is unclear, and enhancing area extends into gastric wall (arrowheads, D).

 


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  		Fig. 1E —82-year-old man with xanthogranulomatous pancreatitis. Photomicrographs of histopathologic specimen show markedly dilated pancreatic ducts with epithelium composed of micropapillary columnar mucous cells, which suggest presence of papillary mucinous adenoma (E, H and E). Foamy macrophages, lymphocytes, and plasma cells have excessively infiltrated atrophic pancreatic tissue (F, H and E). Many foamy macrophages, lymphocytes, and plasma cells also exist in muscular layer of stomach (F). Pools of mucin (arrows, G) are seen in inflammatory foci (G, H and E).

 


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  		Fig. 1F —82-year-old man with xanthogranulomatous pancreatitis. Photomicrographs of histopathologic specimen show markedly dilated pancreatic ducts with epithelium composed of micropapillary columnar mucous cells, which suggest presence of papillary mucinous adenoma (E, H and E). Foamy macrophages, lymphocytes, and plasma cells have excessively infiltrated atrophic pancreatic tissue (F, H and E). Many foamy macrophages, lymphocytes, and plasma cells also exist in muscular layer of stomach (F). Pools of mucin (arrows, G) are seen in inflammatory foci (G, H and E).

 


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  		Fig. 1G —82-year-old man with xanthogranulomatous pancreatitis. Photomicrographs of histopathologic specimen show markedly dilated pancreatic ducts with epithelium composed of micropapillary columnar mucous cells, which suggest presence of papillary mucinous adenoma (E, H and E). Foamy macrophages, lymphocytes, and plasma cells have excessively infiltrated atrophic pancreatic tissue (F, H and E). Many foamy macrophages, lymphocytes, and plasma cells also exist in muscular layer of stomach (F). Pools of mucin (arrows, G) are seen in inflammatory foci (G, H and E).

 

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