A typical feature of groove pancreatitis

Abstract

A 57-year-old man with a history of excessive alcohol intake presented with painless jaundice. Contrast-enhanced abdominal computed tomography demonstrated a heterogeneous 6-cm mass in the pancreatic head associated with cysts in the duodenal wall and pancreatic parenchyma, suggestive of groove pancreatitis (Fig. 1). However, CA 19-9 (carbohydrate antigen 19-9) was elevated at 97.4 U/ml (normal: <34 U/ml). The patient underwent pancreaticoduodenectomy and groove pancreatitis was confirmed on pathological examination. This rare entity is characterized by the presence of numerous large cysts within the thickened duodenal wall, a pancreaticoduodenal groove, and cavities that extend into the pancreatic parenchyma (Fig. 2). Microscopy (Fig. 3) showed histological architectural disruption of the pancreatic parenchyma, chronic inflammation of the pancreaticoduodenal interface (the groove area), Brunner's gland hyperplasia and extensive fibrosis with dilatation of the pancreatic duct. Knowledge of this entity is crucial as it can mimic a pancreatic head cancer.1 Figure 1 Abdominal computed tomography shows the pancreatic head tumour with numerous cysts within the duodenal wall and pancreatic parenchyma Figure 2 Macroscopic appearance of the resected specimen. Observe the thickened duodenal wall with large cysts and a larger cyst in the pancreatic parenchyma Figure 3 Microscopy shows (a) the pancreaticoduodenal interface with chronic inflammation and Brunner's gland hyperplasia (magnification ×100), and (b) extensive fibrosis and mild pancreatic duct dilatation (magnification ×40)