The New Mimicker of Pancreatic Cancer: Sarcoidosis

1Emory University School of Medicine, Atlanta, GA
2Emory University School of Medicine, Atlanta, GA
3Emory University School of Medicine, Atlanta, GA

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 176

Case Presentation:

A 58‐year‐old African American man presented to our hospital with 1‐month history of anorexia with a 20‐pound weight loss and progressive painless jaundice. He denied significant alcohol use and admitted to 25 pack‐year tobacco use. He had a family history of colon cancer and pancreatic cancer. Physical examination revealed a thin man with scleral icterus. The abdomen was nontender and without appreciable masses, hepatosplenomegaly, or lymphadenopathy. The remaining physical exam was unremarkable. Relevant laboratory abnormalities included: AST 105 U/L, ALT 112 U/L, alkaline phosphatase 580 U/L, total bilirubin 6.3 mg/dL INR 2.3, and albumin 2.7 g/dL. CEA and CA19‐9 levels were normal. Hepatitis A, B, and C serologies and autoimmune antibodies were negative. Computed tomography (CT) of the abdomen revealed dilated pancreatic and biliary ducts and a 2.9‐cm mass in the head of the pancreas extending into and partially surrounding the hepatic artery. There were no abnormalities in the liver or spleen. During the hospital course, endoscopic retrograde cholangiopancreatography (ERCP) for sphincterotomy and stent placement was performed, with cytology brushings negative for malignant cells. A CT‐guided pancreatic head biopsy revealed noncaseating granulomas, diagnostic of sarcoidosis. CT of the chest demonstrated no mass or mediastinal lymphadenopathy. In follow‐up, the patient received 40 mg of oral prednisone for 8 weeks, which was then slowly tapered over 6 months. Six months after diagnosis, transminases returned to normal, and the pancreatic mass remained unchanged on repeat CT.

Discussion:

Sarcoidosis is a chronic multiorgan disease with a predilection for the lymph nodes (99%), lungs (90%), myocardium (74%), liver (60%), skin (25%), and eyes (25%). Pancreatic Involvement is rare (1%‐3% prevalence), almost always asymptomatic, and typically only discovered at autopsy. A literature review revealed only 26 reported cases of symptomatic pancreatic sarcoidosis. Isolated pancreatic sarcoidosis without pulmonary or lymph node involvement has not been previously reported. Recommended evaluation of suspected pancreatic sarcoidosis includes: liver viral and autoimmune serologies, CEA, CA 19‐9, angiotensin‐converting enzyme (ACE) levels, abdominal CT with contrast, and biopsy. Recommended management includes: (a) 1‐2 months of systemic steroid therapy with a slow taper over 6 months; (b) annual CT monitoring; and (c) monitoring of liver enzymes, CA 19‐9, and serum ACE levels every 6 months.

Conclusions:

We report the first case of symptomatic sarcoidosis isolated to the pancreas. Sarcoidosis can mimic many medical conditions, now including isolated obstructive pancreatic cancer. It rarely affects the pancreas, but clinicians should be aware that pancreatic masses can be benign in rare situations. Aggressive tissue diagnosis is nearly always indicated.

Author Disclosure:

J. Naik, none; D. Dressier, none; V. Yang, none.

To cite this abstract:

Naik J, Dressier D, Yang V. The New Mimicker of Pancreatic Cancer: Sarcoidosis. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 176. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/the-new-mimicker-of-pancreatic-cancer-sarcoidosis/. Accessed July 16, 2019.

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