A suspicious pancreatic mass in chronic pancreatitis: pancreatic actinomycosis
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F de Clerck1, P Laukens1, V De Wilde1
1Department of Gastroenterology and Hepatology, AZ Sint-Jan, Ruddershove 10, 8000 Bruges, Belgium.
Abstract:
Introduction. Pancreatic actinomycosis is a chronic infection of the pancreas caused by the suppurative Gram-positive bacterium Actinomyces. It has mostly been described in patients following repeated main pancreatic duct stenting in the context of chronic pancreatitis or following pancreatic surgery. This type of pancreatitis is often erroneously interpreted as pancreatic malignancy due to the specific invasive characteristics of Actinomyces. Case. A 64-year-old male with a history of chronic pancreatitis and repeated main pancreatic duct stenting presented with weight loss, fever, night sweats, and abdominal pain. CT imaging revealed a mass in the pancreatic tail, invading the surrounding tissue and resulting in splenic vein thrombosis. Resectable pancreatic cancer was suspected, and pancreatic tail resection was performed. Postoperative findings revealed pancreatic actinomycosis instead of neoplasia. Conclusion. Pancreatic actinomycosis is a rare type of infectious pancreatitis that should be included in the differential diagnosis when a pancreatic mass is discovered in a patient with chronic pancreatitis and prior main pancreatic duct stenting. Our case emphasizes the importance of pursuing a histomorphological confirmation.
Insights
Pancreatic actinomycosis, a rare bacterial infection, can mimic pancreatic cancer, especially after pancreatic duct stenting. Histomorphological confirmation is crucial for accurate diagnosis and treatment.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Surgical Pathology
Background:
- Pancreatic actinomycosis is a rare chronic infection caused by Actinomyces bacteria.
- It often occurs in patients with chronic pancreatitis and prior pancreatic duct stenting.
- The invasive nature of Actinomyces can lead to misdiagnosis as pancreatic malignancy.
Purpose of the Study:
- To highlight pancreatic actinomycosis as a differential diagnosis for pancreatic masses.
- To emphasize the importance of histopathological confirmation in suspected cases.
- To present a case of pancreatic actinomycosis mimicking pancreatic cancer.
Main Methods:
- Case report of a 64-year-old male with chronic pancreatitis and pancreatic duct stenting.
- Clinical presentation including weight loss, fever, and abdominal pain.
- CT imaging revealing a pancreatic tail mass with splenic vein thrombosis.
Main Results:
- Surgical resection was performed due to suspected pancreatic cancer.
- Postoperative pathological examination confirmed pancreatic actinomycosis, not neoplasia.
- The patient's presentation mimicked malignant pancreatic tumors.
Conclusions:
- Pancreatic actinomycosis is a rare infectious pancreatitis that should be considered in patients with pancreatic masses.
- Prior pancreatic duct stenting and chronic pancreatitis are significant risk factors.
- Histomorphological confirmation is essential to differentiate from pancreatic cancer.
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