Shawn Philip, DO1, Omar Tageldin, MD2, Arkar Htoo, MD2, Stephen Hasak, MD2 1Albany Medical Center, Westbury, NY; 2Albany Medical Center, Albany, NY
Introduction: Sarcoidosis is a syndrome that can primarily affect the pulmonary system with a presentation of noncaseating granulomas on pathological analysis. It does not generally affect the gastrointestinal system. Pancreatic sarcoidosis is rarely reported in literature and tissue penetration can lead to a mass-like presentation which may mimic malignancy and even cause inflammation leading to pancreatitis.
Case Description/Methods: We present a case of a 33 y/o female with a history of anxiety, depression, and hypertension who developed increasing abdominal pain and nausea with vomiting with anorexia. Labs showed elevated lipase levels with elevated alkaline phosphate and elevated transaminases. Computed tomography (CT) scan of the abdomen and pelvis showed a 1.4x0.9cm pancreatic tail cyst with fat stranding. Imaging five days later showed enlargement of this cyst with fat stranding consistent with necrotizing pancreatitis. Lipase was elevated with elevated alkaline phosphatase. She underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) that showed a 30 x22 mm pseudocyst in the pancreas tail and a 30 x 15 mm lesion in the pancreatic head with irregular margins. Multiple abnormal lymph nodes were seen in the perigastric region, peripancreatic region, and porta hepatitis which were irregular and hypoechoic. Fine needle biopsy of the head lesion revealed benign tissue with lymph node elements associated with non-necrotizing granuloma consistent with a possible diagnosis of sarcoidosis. Acid-fast bacilli (AFB) stain, Grocott methenamine silver stain (GMS), and culture were negative for infection. ERCP revealed pancreatic duct disruption in the tail for which a pancreatic stent was placed. A distal biliary stricture was treated with biliary sphincterotomy and stent placement. Chest CT showed no radiographic findings of sarcoidosis involving hilar lymph nodes or lunch parenchyma. She eventually had resolution of her pancreatitis and is scheduled to follow with gastroenterology and rheumatology for further testing.
Discussion: Pancreatic sarcoidosis is a rare but may cause of pancreatitis. The differential should be considered with irregular lesions seen in the pancreas with peripancreatic lymphadenopathy. It can be secondary to hypercalcemia or active granulomatous pancreatitis. Tissue biopsy is often needed for diagnosis since laboratory and radiographic techniques may not differentiate this condition from other cancerous or inflammatory issues.
Figure: Fine needle biopsy of the pancreatic head lesion revealed benign tissue with lymph node elements associated with non-necrotizing granuloma
Shawn Philip indicated no relevant financial relationships.
Omar Tageldin indicated no relevant financial relationships.
Arkar Htoo indicated no relevant financial relationships.
Stephen Hasak indicated no relevant financial relationships.
Shawn Philip, DO1, Omar Tageldin, MD2, Arkar Htoo, MD2, Stephen Hasak, MD2. P1140 - Sarcoidosis in the Pancreas: A Unique Presentation of Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.