A Seventy-one-year-old man presented with icterus and malaise. A computed tomography scan showed a tissue mass in the head of the pancreas with compression and dilation of the common bile duct. The patient underwent endoscopic retrograde cholangiopancreatography, a metal stent was placed in the common bile duct and a pancreatoduodenectomy was planned. At operation invasion in the portal vein was observed. On-site histopathology of the tissue revealed only inflammation and no cancer cells. It was therefore decided to perform a gastroenterostomy instead. As autoimmune pancreatitis was suspected, treatment with corticosteroids was started, but did not result in a reduction of tissue mass. After a few months, the patient developed venous thrombosis in the portal and superior mesenteric veins, with colorectal varicose veins and episodes of bleeding. The patient died of excessive weight loss due to mesenteric venous thrombosis. Post-mortem histopathological examination of the soft tissue mass of the head of the pancreas showed signet ring cell carcinoma.
Sjoukje Nauta, Iris Knoester, Monica van Zanten, Erwin van Geenen