SCLEROSING PANCREATITIS SHOWING RAPIDLY PROGRESSIVE CHANGES WITH RECURRENT MASS FORMATION

Conclusion. Sclerosing pancreatitis might develop repeatedly or might rapidly extend to the whole pancreas with recurrent mass formation. Ba ckground. Nothing is known concerning course or development of scleros ing pancreatitis. Methods. A 63-yr-old male was followed up for 2.5 yr . Results. The patient was admitted because of a tumor in the body and tail of the pancreas. Serum pancreatic enzymes were transiently eleva ted, but tumor markers were all negative. Imaging studies showed a tum or 7 cm in size. The main pancreatic duct was normal in the head and o bstructed at the body on endoscopic retrograde pancreatography (ERCP). The K-ras oncogene mutation was positive in pure pancreatic juice. Di stal pancreatectomy was performed because pancreatic cancer was highly suspected. Pathological findings showed that the tumor was a densely fibrotic mass without malignant cells. Inflammatory cell infiltration was observed in the stroma. One year later, another mass 3 cm in size was noted in the remnant pancreatic head. ERCP revealed diffuse irregu lar narrowing of the main pancreatic duct, its branches, and the commo n bile duct. Liver dysfunction improved and an elevation of serum panc reatic enzymes subsided without any specific treatment, and the mass d iminished in size. The patterns of various imaging studies on the seco nd tumor were the same as those of the previous resected mass. Cortico steroid was not administered.