Undistinguishable <i>Cryptococcus</i>-related granulomatous lesion from carcinoma in the tail of the pancreas: a case report

  • TSUDA Kei
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • OHNO Akihisa
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • HIJIOKA Masayuki
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • KAKU Toyoma
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • MOMOSAKI Masaya
    Department of Pathology, National Hospital Organization Kyushu Medical Center
  • RYU Tomoki
    Department of Hepatology, Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Medical Center
  • TAKAMI Yuko
    Department of Hepatology, Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Medical Center
  • HARADA Naohiko
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • NAKAMUTA Makoto
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
  • KAWABE Ken
    Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center

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Other Title
  • 主膵管狭窄を呈し膵尾部癌との鑑別が困難であったクリプトコッカスによる肉芽腫性病変の1例

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<p>Abdominal computed tomography revealed a 19×13mm delayed enhancing mass and dilation of the distal pancreatic duct in the head of the pancreas. Magnetic resonance cholangiopancreatography showed pancreatic duct stenosis in the tail of the pancreas. Endoscopic retrograde pancreatography revealed an abrupt interruption of the main pancreatic duct at the tail of the pancreas. We could not assess the distal side of the pancreatic stenosis due to the large extent of obstruction. The pancreatic head mass was diagnosed as adenocarcinoma using endoscopic ultrasound-fine needle aspiration biopsy. However, we could not determine whether the pancreatic duct stenosis in the tail of the pancreas was malignant. Nevertheless, we performed a total pancreatectomy with splenectomy. Histological examination showed poorly differentiated adenocarcinoma in the pancreatic head mass but the pancreatic duct stenosis in the tail of the pancreas was diagnosed as pancreatic granuloma caused by Cryptococcus. Fungal infections may reportedly promote the development of pancreatic cancer, as further suggested by this case of cryptococcal infection.</p>

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