Lymphoplasmacytic sclerosing pancreatitis with obstructive jaundice: CT and pathology features

The clinical presentation of lymphoplasmacytic sclerosing pancreatitis (LPSP) can be very similar to that of pancreatic cancer, with no statistically significant differences in the rates of abdominal pain, weight loss, jaundice, or levels of carcinoembryonic agent or cancer antigen 19-9. The purpose of this study is to describe and illustrate the CT features of LPSP presenting with obstructive jaundice and to correlate CT and pathology findings.

Five patients with LPSP were evaluated. Morphologic features of the pancreas on CT scans, including the size of the pancreas, presence or absence of a mass, segmental difference of contrast enhancement, pancreatic duct, major pancreatic vasculature, and biliary tract, were retrospectively evaluated and correlated with histopathology. The degree of contrast enhancement of the pancreas was compared in 10 patients without LPSP, who were scanned with the same protocol.

CT scans showed diffuse (n = 2) or focal (n = 3) enlargement of the pancreatic head. The normal lobular appearance of the pancreas was effaced, and the gland appeared featureless in the involved region. Enlarged areas showed an enhancement pattern similar to that of the rest of the pancreas, and no segmental difference of contrast enhancement was identified. Pancreatic duct dilatation was not seen in any patient. Thickening and contrast enhancement of the common bile duct wall (n = 4) and gallbladder wall (n = 3) were observed and were pathologically correlated with inflammatory infiltrate and fibrosis of the common bile duct (n = 3) and gallbladder (n = 1).

When these findings are encountered, further evaluation with serologic tests or biopsy may aid in the diagnosis of LPSP.