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Xu AA, Vincent S, Ma S, Catania V, Zarrin-Khameh N. Crohn's Disease-Associated Granulomatous Pancreatitis With Exocrine Pancreatic Insufficiency. ACG Case Rep J 2024; 11:e01428. [PMID: 39081299 PMCID: PMC11286247 DOI: 10.14309/crj.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/03/2024] [Indexed: 08/02/2024] Open
Abstract
Extraintestinal manifestations of inflammatory bowel disease occur commonly and can lead to considerable morbidity. Pancreatic manifestations of inflammatory bowel disease have been reported to be more common in Crohn's disease (CD) than ulcerative colitis. We report a case of granulomatous inflammation in the body of the pancreas with exocrine pancreatic insufficiency, which prompted a diagnosis switch from ulcerative colitis to CD. This is of interest to readers to remind them that pancreatic manifestations can occur and are more common in CD.
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Affiliation(s)
- Anthony A. Xu
- Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sara Vincent
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Samuel Ma
- School of Medicine, Baylor College of Medicine, Houston, TX
| | | | - Neda Zarrin-Khameh
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
- Ben Taub Hospital, Houston, TX
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Raffaeli E, Cardinali L, Fianchini M, Brancorsini D, Mosca P, Marmorale C. Inflammatory myofibroblastic tumor of the transverse colon with synchronous gastrointestinal stromal tumor in a patient with ulcerative colitis: a case report. Int J Surg Case Rep 2019; 60:141-144. [PMID: 31220684 PMCID: PMC6584907 DOI: 10.1016/j.ijscr.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) is a rare proliferative disease of uncertain etiology, characterized by the proliferation of fusate or epithelioid myofibroblasts admixed with predominantly mononuclear inflammatory cells. IMT is generally considered a benign lesion, although in some cases this neoplasm has shown an aggressive behavior in terms of local recurrence and metastasis. We report the case of a patient with a ten-year history of ulcerative colitis affected by IMT of the transverse colon and by synchronous gastrointestinal stromal tumor (GIST) of stomach. PRESENTATION OF CASE A 59-year-old woman with a ten-year history of ulcerative colitis has been admitted to our hospital with signs and symptoms of acute recurrence of ulcerative colitis: abdominal pain, diarrhea, hematochezia and rectal tenesmus. Colonoscopy showed a left colon with diffuse hyperemia, mucosal erosions and a 2-cm, irregularly shaped, polypoid lesion at the level of the transverse colon. Histopathological examination of the specimen obtained via biopsy of the polypoid lesion has revealed a mesenchymal neoplasm with uncertain characters of malignancy. Due to the severity of the inflammatory bowel disease resistant to immunosuppressive and steroid drug treatment, surgical indication was given. DISCUSSION Although the relationship between IMT and Crohn's disease has been widely reported in literature, the relationship between IMT and ulcerative colitis has never been previously described. CONCLUSION To the best of our knowledge, this is the first case of IMT associated with ulcerative colitis reported in literature and the synchronous association with a gastric GIST represents another primacy.
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Affiliation(s)
- Eugenia Raffaeli
- Department of General Surgery, Polytechnic University of Marche - Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Ancona, Italy
| | - Luca Cardinali
- Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy.
| | - Maurizio Fianchini
- Department of General Surgery, Polytechnic University of Marche - Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Ancona, Italy
| | - Donatella Brancorsini
- Section of Pathological Anatomy and Histopathology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Ancona, Italy
| | - Piergiorgio Mosca
- Digestive System Diseases, Endoscopy and Inflammatory Bowel Diseases Unit, Ospedali Riuniti, Ancona, Italy
| | - Cristina Marmorale
- Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy
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van Tonder F, Seale M, Yong E, Hill P, Darby J, Sutherland T. Mass-forming renal Crohn's disease: a case report with multimodality imaging. BJR Case Rep 2016; 2:20150159. [PMID: 30460004 PMCID: PMC6243327 DOI: 10.1259/bjrcr.20150159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 04/06/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
The most common extraintestinal manifestations of Crohn’s disease involve the eyes, skin, hepatobiliary tract, and the musculoskeletal and respiratory systems. Mass-forming granulomatous inflammation in extraintestinal organs is extremely rare and there are only a few reports of patients with Crohn’s disease presenting with inflammatory pseudotumours of the liver, pancreas and kidneys. We present a case of a mass-forming renal granulomatous inflammation in an adult female with Crohn’s disease. The clinical, pathological and imaging features of this case illustrate that renal inflammatory pseudotumour is a rare but important differential diagnosis of a renal mass in patients with Crohn’s disease and that radiologists should be aware of its existence when considering other more common pathologies, such as focal pyelonephritis and renal tumours. Renal inflammatory pseudotumour may have relatively non-specific imaging features and a biopsy may be required to make the diagnosis.
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Affiliation(s)
- Frans van Tonder
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Melanie Seale
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Eric Yong
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Prue Hill
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Jonathan Darby
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Tom Sutherland
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, VIC, Australia
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Riedlinger WFJ, Lairmore TC, Balfe DM, Dehner LP. Tumefactive Necrobiotic Granulomas (Nodulosis) of the Pancreas in an Adult with Long-Standing Rheumatoid Arthritis. Int J Surg Pathol 2016; 13:207-10. [PMID: 15864386 DOI: 10.1177/106689690501300213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rheumatoid nodules are well-documented clinical and pathologic lesions in patients with seropositive rheumatoid arthritis (RA). The current report documents the occurrence of rheumatoid nodulosis of the pancreas in an adult woman with a 7-year history of seropositive RA who presented with upper abdominal pain and was found to have multiple masses in the body and tail of the pancreas by imaging studies. An elevated serum pancreatic polypeptide (PP) and the development of new lesions in the pancreas prompted a subsequent distal pancreatectomy. The lesions in the pancreas proved to be necrobiotic palisading and hyalinizing granulomas upon pathologic examination. Also, of interest, elevation of serum PP has been observed in patients with RA and other systemic noninfectious and infectious inflammatory disorders in the absence of a pancreatic or intestinal neuroendocrine neoplasm.
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Affiliation(s)
- Wolfram F J Riedlinger
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Barnes-Jewish Hospital at Washington University Medical Center, Saint Louis, Missouri, USA
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Conrad C, Fernández-Del Castillo C. Preoperative evaluation and management of the pancreatic head mass. J Surg Oncol 2012; 107:23-32. [PMID: 22674403 DOI: 10.1002/jso.23165] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 05/01/2012] [Indexed: 12/16/2022]
Abstract
The differential diagnosis of a pancreatic head mass encompasses a wide range of clinical entities that include both solid and cystic lesions. This chapter focuses on our approach to the patient presenting with a newly found pancreatic head mass with the main goals of determining the risk of the lesion being malignant or premalignant, resectability if the patient is appropriate for surgical intervention, assessment of need for multimodality treatment and determination the patient's surgical risk.
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Affiliation(s)
- Claudius Conrad
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 021114, USA.
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Derrey S, Charpentier C, Gérardin E, Langlois O, Touchais JY, Lerebours E, Proust F, Laquerrière A. Inflammatory Pseudotumor of the Cerebellum in a Patient with Crohn's Disease. World Neurosurg 2012; 77:201.e13-6. [DOI: 10.1016/j.wneu.2011.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 04/05/2011] [Accepted: 05/13/2011] [Indexed: 10/15/2022]
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Renal involvement in Crohn's disease: granulomatous inflammation in the form of mass lesion. Eur J Gastroenterol Hepatol 2011; 23:1267-9. [PMID: 21915060 DOI: 10.1097/meg.0b013e32834b956b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Extraintestinal manifestations of Crohn's disease (CD) are varied and concentrated mainly to the skin and eye. Urinary tract or renal involvement is extremely rare. Herein we report on a case of renal lesion of a 50-year-old woman with a 15-year history of CD. Abdominal computed tomography scan of the patient identified heterogeneous multinodular mass lesions in the left kidney. Histology proved classic granulomatous inflammatory nodules with multinucleated giant cells, eosinophils, plasma cells, epithelioid cells, and spindle-shaped myofibroblasts in the areas, where the computed tomography scan indicated. After the extensive PubMed search in the literature, this is the first macroscopically documented and histologically proved, mass-like renal involvement in CD. From now on, differential diagnostics of renal mass lesions in CD should include the tumor-like, Crohn's-type granulomatous inflammation as direct kidney manifestation of the disease.
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Manzia TM, Toti L, Lenci I, Attia M, Tariciotti L, Bramhall SR, Buckels JAC, Mirza DF. Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration. Ann R Coll Surg Engl 2010; 92:295-301. [PMID: 20385044 PMCID: PMC3025206 DOI: 10.1308/003588410x12628812458374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION We assessed the incidence and outcome of pancreaticoduodenectomy for patients with a pre-operative benign diagnosis and in patients who had an unexpected diagnosis of benign disease following resection. We have also compared how the introduction of endoscopic ultrasound fine needle aspiration (EUS-FNA) has altered our pre-operative assessment. PATIENTS AND METHODS Between January 1997 and April 2006, 499 patients underwent pancreaticoduodenectomy at the Queen Elizabeth Hospital. Data were collected prospectively. A further 85 patients between 2006 and 2008 had a different diagnostic approach (after imaging these patients have been also studied by EUS-FNA). RESULTS Overall, 78 (15.6%) patients had no malignant disease on final histology. Out of 459 patients who underwent pancreaticoduodenectomy for presumed malignancy, 49 (10.6%) had benign disease (sensitivity, 97%; positive predictive value, 89%). In a further 40 patients with a pre-operative benign diagnosis, we found 11 cases (27%) of malignancy (sensitivity, 37%; negative predictive value, 72%). Following the introduction of EUS-FNA, the sensitivity and specificity of the diagnostic work were 92% and 75%, respectively (positive predictive value, 93%; negative predictive value, 63%). The median follow-up was 35 months (range, 1-116 months). CONCLUSIONS Prior to the introduction of EUS-FNA, a significant number of patients, in whom pancreaticoduodenectomy is carried out for suspected benign disease, turn out to have an underlying malignancy. The use of EUS-FNA has improved the specificity of diagnostic work-up.
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Affiliation(s)
- Daniel Wolfson
- Department of Medicine, George Washington University Medical Center, Washington, DC, USA
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DeRubertis BG, McGinty J, Rivera M, Miskovitz PF, Fahey TJ. Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas. Surg Endosc 2004; 18:1001. [PMID: 15054650 DOI: 10.1007/s00464-003-4546-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 11/04/2003] [Indexed: 10/26/2022]
Abstract
An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.
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Affiliation(s)
- B G DeRubertis
- Department of Surgery, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA
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Abraham SC, Wilentz RE, Yeo CJ, Sohn TA, Cameron JL, Boitnott JK, Hruban RH. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all 'chronic pancreatitis'? Am J Surg Pathol 2003; 27:110-20. [PMID: 12502933 DOI: 10.1097/00000478-200301000-00012] [Citation(s) in RCA: 233] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pancreaticoduodenectomy (Whipple resection) has evolved into a safe procedure in major high-volume medical centers for the treatment of pancreatic adenocarcinoma and refractory chronic pancreatitis. However, some Whipple resections performed for a clinical suspicion of malignancy reveal only benign disease on pathologic examination. We evaluated the frequency of such Whipple resections without tumor in a large series of pancreaticoduodenectomies and classified the diverse pancreatic and biliary tract diseases present in these specimens. Of 442 Whipple resections performed during 1999-2001, 47 (10.6%) were negative for neoplastic disease and, in 40 cases, had been performed for a clinical suspicion of malignancy. Most Whipple resections revealed benign pancreatic disease, including 8 (17%) alcohol-associated chronic pancreatitis, 4 (8.5%) gallstone-associated pancreatitis, 1 (2.1%) pancreas divisum, 6 (12.8%) "ordinary" chronic pancreatitis of unknown etiology, and 11 (23.4%) lymphoplasmacytic sclerosing pancreatitis. In particular, patients with lymphoplasmacytic sclerosing pancreatitis were all thought to harbor malignancy, whereas only 13 of 19 (68.4%) of Whipple resections showing histologically "ordinary" forms of chronic pancreatitis were performed for a clinical suspicion of malignancy. Benign biliary tract disease, including three cases of primary sclerosing cholangitis, two cases of choledocholithiasis-associated chronic biliary tract disease, and four fibroinflammatory strictures isolated to the intrapancreatic common bile duct, was a common etiology for clinically suspicious Whipple resections (22.5% of cases). Pancreatic intraepithelial neoplasia (PanIN) was a common finding among all pancreata, whether involved by pancreatitis or histologically normal. Overall, PanIN 1A/1B was present in 68.1%, PanIN 2 in 40.4%, and PanIN 3 in just 2.1%. These findings indicate that "benign but clinically suspicious" Whipple resections are relatively common in high-volume centers (9.2%) and reveal a diverse group of clinicopathologically distinctive pancreatic and biliary tract disease.
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Affiliation(s)
- Susan C Abraham
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, 55905, USA.
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