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Eosinophilic pancreatitis with pseudocyst.Indian
J Gastroenterol. 2007 May-Jun;26(3):136-7.
Eosinophilic
pancreatitis is a rare entity in patients having underlying systemic
manifestations such as peripheral eosinophilia, elevated serum IgE
levels and/ or eosinophilic infiltrates in other organs, including
the gastrointestinal tract. We report a 38-year-old woman with
peripheral eosinophilia in association with acute pancreatitis,
pancreatic ascites and pseudocyst.
Eosinophilic
pancreatitis mimicking pancreatic neoplasia.Can
J Gastroenterol. 2006 May;20(5):361-4.
Eosinophilic
pancreatitis (EP) is a rare disease. It typically occurs in the
setting of either eosinophilic gastroenteritis or the
hypereosinophilic syndrome. Isolated eosinophilic infiltration of
the pancreas is less common. EP usually presents as a pancreatic
tumour with abdominal pain and/or obstructive jaundice. The
diagnosis is often not made until after pancreatic resection under
suspicion of a pancreatic tumour. The case of a 14-year-old boy
whose initial presentation was suggestive of a pancreatic tumour is
reported. Radiological evaluation revealed a pancreatic mass
suggestive of a pancreatic tumour obstructing the duodenum and
common bile duct. The patient underwent surgery and a gastrojejunal
anostomosis, tube cholecystostomy and biopsy were performed with no
postoperative complications. The diagnosis of EP was established
after surgical biopsy. The biopsy specimen revealed prominent
eosinophilic infiltration. Serum immunoglobulin E levels were
elevated. The patient was treated with oral prednisolone (40
mg/day). After two months of oral steroid therapy, clinical
manifestations rapidly improved and peripheral eosinophilia
subsided. Computed tomography scan revealed remission of the
pancreatic mass-like lesion.
Eosinophilic
pancreatitis and increased eosinophils in the pancreas.
Am J Surg
Pathol. 2003 Mar;27(3):334-42.
Prominent
eosinophilic infiltrates are an unusual finding in the pancreas.
Eosinophilic pancreatitis is one rare etiology of pancreatic
eosinophilia, but other described causes of eosinophilic infiltrates
have also included pancreatic allograft rejection, pancreatic
pseudocyst, lymphoplasmacytic sclerosing pancreatitis (LPSP),
inflammatory myofibroblastic tumor, and histiocytosis X. In this
study we describe the clinicopathologic features of three new cases
of eosinophilic pancreatitis and conduct a retrospective 18-year
institutional review of the myriad disease processes associated with
pancreatic eosinophilia. In the files of the Johns Hopkins Hospital,
<1% of all pancreatic specimens had been noted to show increased
numbers of eosinophils. Eosinophilic pancreatitis itself was a rare
etiology for pancreatic eosinophilia, with only one in-house case
over the 18-year study period and two additional referral cases.
Other disease processes associated with prominent eosinophilic
infiltrates were more common and included pancreatic allograft
rejection (14 cases), LPSP (5 of 24 total LPSP cases evaluated),
inflammatory myofibroblastic tumor (4 cases), and systemic
mastocytosis (1 case). Patients with eosinophilic pancreatitis
showed two distinct histologic patterns: 1) a diffuse periductal,
acinar, and septal eosinophilic infiltrate with eosinophilic
phlebitis and arteritis; and 2) localized intense eosinophilic
infiltrates associated with pseudocyst formation. All three patients
with eosinophilic pancreatitis had peripheral eosinophilia, and all
had multiorgan involvement. One patient with LPSP also had marked
peripheral eosinophilia, and 5 of 24 LPSP cases demonstrated
prominent eosinophilic infiltrates in the gallbladder, biliary tree,
and/or duodenum. Notably, not all of these patients with LPSP with
prominent eosinophils in other organs had increased eosinophils in
the pancreas itself. These results emphasize the infrequent nature
of pancreatic eosinophilia and its multiple potential disease
associations. True eosinophilic pancreatitis, although a fascinating
clinicopathologic entity, is one of the rarest causes of pancreatic
eosinophilia.
A case of eosinophilic pancreatitis.Korean
J Gastroenterol. 2003 Nov; 42(5) :444-50.
Eosinophilic
pancreatitis is a rare disorder that may only be diagnosed after
pancreatic resection under the suspection of a pancreatic tumor. We
experienced a 65-year-old female patient whose initial presentation
suggested pancreatic cancer. Radiologic evaluation revealed a
pancreatic mass-like lesion which was obstructing the main
pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP)
showed double duct strictures involving the distal common bile duct
and the main pancreatic duct. Serum IgE level was elevated.
Percutaneous core needle biopsy with an 18-gauge needle was
performed targeting the pancreatic lesion. The biopsy specimen
revealed fibrotic interlobular septum and intralobular fibrosis with
prominent eosinophilic infiltration. The patient was treated with
oral prednisolone (40 mg/day). A plastic stent was inserted into the
narrowed common bile duct. After three months of oral steroid
therapy, symptoms and signs improved rapidly and serum IgE level was
decreased. Abdominal computed tomography and ERCP revealed remission
of pancreatic mass-like lesion.
Eosinophilic pancreatitis: a rare entity that can
mimic a pancreatic neoplasm.
Ann Diagn Pathol. 2000 Dec;4(6):379-85.
Eosinophilic
pancreatitis is a rare disorder that is frequently diagnosed only
after pancreatic resection for suspected pancreatic tumor. It
typically occurs in the setting of either eosinophilic
gastroenteritis or the hypereosinophilic syndrome. Isolated
eosinophilic infiltration of the pancreas is less common. We
describe a case of a 36-year-old man who presented with the clinical
symptoms of acute pancreatitis. Radiologic evaluation revealed an
obstructive pancreatic lesion suspicious for carcinoma. Pathologic
examination of the resection specimen revealed a dense infiltrate of
eosinophils in the pancreas. Although an uncommon condition,
eosinophilic pancreatitis is a syndrome lacking well-defined causes
that can be associated with eosinophilic gastroenteritis, a
treatable condition, or the potentially fatal hypereosinophilic
syndrome. While the radiographic features of this condition can vary
widely, eosinophilic infiltration of the pancreas with or without
involvement of the gastrointestinal tract is the pathologic feature
common to all of the previously reported cases.
Eosinophilic
pancreatitis: a rare manifestation of digestive allergy?
Gastroenterol Clin Biol. 1989 Aug-Sep;13(8-9):731-3.
We report a
case of subacute pancreatitis in a 26-year-old woman, who underwent
partial pancreatectomy after a two-week history of abdominal pain.
The patient had a long history of allergy. She did not show any well
recognized cause of acute or chronic pancreatitis. This patient was
thought to have eosinophilic pancreatitis because of the presence of
a prominent eosinophilic infiltrate in the resected pancreas.
Eosinophilic infiltration of the pancreas has been reported very
rarely in the literature, and is usually associated with more
generalized disease. In our case there was no extrapancreatic
involvement, as shown by repeatedly normal blood eosinophil counts,
and by histologically normal spleen, celiac lymph nodes, and
gastroduodenal biopsies. We suggest that an allergic mechanism might
be responsible for this patient's disease, based on past history of
allergic manifestations and the important increase in her serum IgE.
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