Dados do Trabalho

Título

CASE REPORT: PALLIATIVE BILIODIGESTIVE DERIVATION IN A PATIENT WITH PSEUDOTUMORAL PANCREATITIS MISTAKEN FOR NEOPLASTIC LESION

Apresentação do Caso

A 65-years-old female patient was referred to our hospital after an episode of cholangitis, preceded by 2 months of chronic abdominal pain and significant weight loss. A initial tomography revealed enlargement of the pancreatic head, with ill-defined borders, and dilation of the main pancreatic duct and bile ducts, raising suspicion for neoplasm. At that moment, the patient had mild cholangitis but improved with antibiotics and support. Considering the possibility of papillary neoplasm or IPMN as differential diagnoses, endoscopic ultrasound (EUS) was performed. The MRI was not available. EUS showed a heterogeneous mass in the head of the pancreas measuring 3.8x4.5cm, involving the splenomesenteric confluence and the superior mesenteric artery. The biopsy of the mass was inconclusive.
Following a multidisciplinary discussion at the tumor board, the lesion was deemed as non-operable, and a palliative biliopancreatic derivation was performed 2 days later to correct the cholestasis. Intraoperative findings confirmed the mass characteristics. The surgery was successful, and the patient was discharged 8 days later. The anatomopathological analysis of the intraoperative pancreatic biopsy and suspected lymph nodes showed no atypia or neoplastic cells. EUS was repeated 60 days later, and a new biopsy post-surgery stabilished pseudotumoral pancreatitis. Treatment with pancreatin and multimodal analgesia was initiated.

Discussão

Pseudotumoral pancreatitis and pancreatic adenocarcinoma can present with similar clinical and radiological features, leading to diagnostic challenges. Pseudotumoral pancreatitis may mimic malignancy due to inflammatory changes and edema, typically resulting from chronic inflammation, often linked to alcohol abuse or gallstones. In contrast, pancreatic adenocarcinoma is aggressive and often diagnosed late. Differentiating these entities is crucial, as pseudotumoral pancreatitis may resolve with conservative treatment, whereas pancreatic adenocarcinoma requires surgical intervention and oncological management. Advanced imaging techniques and histopathological analysis are vital for accurate diagnosis.

Comentários Finais

To avoid confusion between these conditions, thorough clinical histories, including risk factors are essential. In this case, an MRI might have provided additional insights, and frozen section biopsy could have been utilized. Involving a multidisciplinary team and conducting long-term follow-up can further ensure accurate diagnosis and treatment.