case_images: PMC4009261_01
case_images: Initial presentation. Periampullary (pancreatic head) mass and dilated pancreatic duct.
case_images: CRIM2014-410142.001.jpg
case_images: PMC4009261_01_CRIM2014-410142.001.jpg
case_images: fig1
case_images: There was a strong suspicion of pancreatic carcinoma (Figure 1).
case_images: (a) and (b) Hematoxylin and eosin stain of the peripancreatic lymph node showing epithelioid granuloma.
case_images: CRIM2014-410142.002.jpg
case_images: PMC4009261_01_CRIM2014-410142.002.jpg
case_images: fig2
case_images: Endoscopic ultrasound- (EUS-) guided fine needle aspiration (FNA) of the pancreatic mass showed reactive atypia with no evidence of malignancy and celiac lymph node FNA cytology showed atypical cells with granuloma (Figures 2(a) and 2(b)).
case_images: Six months after initial presentation. Persistent enlargement of peripancreatic lymph nodes and pancreatic duct dilatation.
case_images: CRIM2014-410142.003.jpg
case_images: PMC4009261_01_CRIM2014-410142.003.jpg
case_images: fig3
case_images: CT scan showed increase in the size of lymph nodes and persistent common bile duct and pancreatic duct dilatation (Figure 3).
case_images: 18 months after initial presentation. (a) CT showing persistent enlarged peripancreatic lymph nodes, pancreatic atrophy, and dilatation of pancreatic duct. (b) Ultrasound abdomen showing enlarged peripancreatic lymph nodes.
case_images: CRIM2014-410142.004.jpg
case_images: PMC4009261_01_CRIM2014-410142.004.jpg
case_images: fig4
case_images: ATT and steroids continued to show enlarged lymph nodes in the porta hepatis, peripancreatic regions, dilated CBD, and pancreatic duct with atrophic looking pancreas (Figures 4(a) and 4(b)). At present, patient is doing well with minimal symptoms and is able to maintain weight.