Cholesterol crystal embolization presenting as either solid or cystic pancreatic lesion

Area of Science:

• Cardiovascular Medicine
• Gastroenterology
• Pathology

Background:

• Cholesterol crystal embolization (CCE) is a recognized cause of end-organ ischemia, often associated with vascular procedures or atherosclerosis.
• The clinical presentation of CCE can be variable, making diagnosis challenging.
• Pancreatic involvement in CCE is uncommon but has been reported.

Observation:

• This retrospective study reviewed clinicopathologic data from two patients presenting with pancreatic manifestations of CCE.
• The first patient had chronic atrial fibrillation and presented with a subacute pancreatic mass.
• The second patient had coronary artery disease and presented with acute pancreatitis and pancreatic cystification.

Findings:

• Both patients had underlying conditions predisposing to CCE, including arrhythmias and coronary artery disease.
• CCE was confirmed as the underlying pathology in both cases, leading to pancreatic injury.
• The diverse presentations underscore the varied clinical spectrum of CCE.

Implications:

• Cholesterol crystal embolization should be considered in the differential diagnosis of pancreatic masses, particularly in patients with risk factors.
• Early recognition of CCE is crucial for appropriate management and to prevent further end-organ damage.
• Further research may elucidate the specific mechanisms and optimal treatment strategies for CCE affecting the pancreas.