Sarcoidosis Masquerading as Pancreatic Cancer
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چکیده
CASE REPORT A49-year-old African American woman with no past medical history was referred to the surgery clinic for a pancreatic head mass. This lesion was discovered incidentally on a computed tomography (CT) scan of the abdomen which was done as part of her evaluation in the emergency room of an outside hospital following a motor vehicle collision. Prior to presentation in the clinic she complained of mild intermittent pruritis and abdominal discomfort. She was otherwise healthy. At the outside hospital, she had a CT guided biopsy of the mass which was negative for malignant cells. She was referred to our institution for further evaluation and possible pancreatoduodenectomy (Whipple procedure). Physical examination was unremarkable. Her laboratory studies were significant for alkaline phosphatase of 1040 U per liter, total bilirubin of 1.5 mg per deciliter, alanine aminotransferase of 237 U per liter, aspartate aminotransferase of 206 U per liter, CA 19-9 of 130 U per milliliter, calcium of 9.7 mg per deciliter, and albumin of 3.4 g per deciliter. Antinuclear antibodies, anti-smooth muscle antibodies, and antimitochondrial antibodies were negative. The remainder of her laboratory analysis was within normal limits. Abdominal CT scan (Figure 1) revealed intrahepatic ductal dilatation and a soft tissue density within the gallbladder fossa extending along the head of the pancreas and the celiac axis. An irregular low density area was noted at the head of the pancreas and calcified gallstones were visualized as well. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and revealed dilated intrahepatic ducts with a stricture in the hilum (Figure 2). A stent was placed to relieve the obstruction. Brushings were sent for cytology and ultimately were negative. A surgical consultation advised that the patient was not a surgical candidate for excision, as the CT showed that the mass was encasing the celiac artery. A repeat abdominal CT scan with biopsy was performed and the biopsy was A CASE TO REMEMBER
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