An unusual cause of pancreatitis.


Question: A 51-year-old man presented with severe epigastric abdominal pain, an amylase of 171 U/L (normal, 25–115) and lipase of 3365 U/L (normal, 114 –286). Computed tomography (CT) of the abdomen and pelvis demonstrated localized heterogenous hypoattenuation in the tail of the pancreas (TOP) with adjacent inflammatory changes consistent with acute pancreatitis with no evidence of gallbladder disease. He denied alcohol use, had a normal serum triglyceride level, and was treated conservatively for acute pancreatitis of unclear etiology. Follow-up magnetic resonance imaging demonstrated a subtle, 1.1 1.4-cm TOP mass with an appearance suggestive of a neuroendocrine tumor (Figure A). Positron emission tomography/CT failed to show any evidence of F-18 fluorodeoxyglucose avid malignant disease. On endoscopic ultrasound (EUS) examination performed 4 months later, a slightly hypoechoic TOP mass was demonstrated (Figure B; upper panel, arrow denoting pancreatic duct (PD) with an adjacent upstream area of hypoechoic, lobulated and atrophic pancreas). There was a sharp demarcation between the abnormal parenchyma upstream of the mass and the normal parenchyma downstream of the mass (Figure B, lower panel). The splenic vein seemed to be encased by the TOP mass. The remainder f the EUS examination was unremarkable. The mass was sampled with a 25-gauge fine needle aspiration (FNA) revealing a highly ellular smear of epithelial cells with acinar features, including granular eosinophilic cytoplasm, round to oval nuclei and mild nisonucleosis (Figure C, left inset). The patient underwent a distal pancreatectomy with splenectomy (Figure C, right inset). What is the etiology of the pancreatitis? See the GASTROENTEROLOGY web site ( for more information on submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest: The authors disclose no conflicts. © 2011 by the AGA Institute 0016-5085/$36.00 doi:10.1053/j.gastro.2010.12.040

DOI: 10.1053/j.gastro.2010.12.040

Cite this paper

@article{Im2011AnUC, title={An unusual cause of pancreatitis.}, author={Gene Y Im and Stavros N. Stavropoulos and Beth Ann Schrope}, journal={Gastroenterology}, year={2011}, volume={141 6}, pages={e9-e10} }