Abstract
A 70-year-old man consulted a private physician about upper abdominal pain. The patient was referred to our hospital with a diagnosis of pancreatic head tumor. Abdominal ultrasonography (US) and dynamic computed tomography (CT) revealed a tumor in the head of the pancreas and defective pancreatic body and tail. Celiac angiography showed neither hypervascularity nor pooling sign in the pancreatic head region. Endoscopic retrograde cholangiopancreatography (ERCP) showed disruption of the main pancreatic duct and endoscopic US in the second portion of duodenum revealed a tumor of the pancreatic head and low echoic lesion spreading to the muscle layer of the duodenum. Based on these clinical findings, we preoperatively diagnosed pancreatic cancer and undertook total pancreatectomy. Pathological findings revealed the tumor to be chronic pancreatitis with a pseudotumor. Immunostaining for anti-pancreatic polypeptide (PP) showed the islets of Langerhans in the tail of pancreas containing few PP cells. Accordingly, the resected specimen had dorsal anlagen and the final diagnosis was chronic pancreatitis with a pseudotumor associated with dysplasia of the pancreatic body and tail.
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