Wijkstrom Martin, Bechara Rabih I, Sarmiento Juan M
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Am Surg. 2010 Jan;76(1):79-84.
Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all genetic backgrounds. Pancreatic involvement is rare; the first case was described on autopsy in 1937. We present a case of pancreatic sarcoidosis without a history of the disease presenting as biliary obstruction mimicking pancreatic malignancy. We also review the literature with respect to management and outcomes of similar cases. The patient described here presented with all the signs and symptoms of a pancreatic malignancy, which was confirmed on a CT scan; the positron emission tomography scan and the CA 19-9 level were also confirmatory of the suspected diagnosis. In this setting, if the mass looks resectable, a Whipple procedure would be the next logical step. However, such strategy would be aggressive management for a benign condition that could be palliated with diverting rather than resective procedures without changing the outlook of the disease. We suggest keeping a high index of suspicion in patients with a history of the disease if demographic concordance exists.
结节病是一种病因不明的全身性肉芽肿性疾病，可影响所有遗传背景的患者。胰腺受累较为罕见；首例病例于1937年在尸检中被描述。我们报告一例无结节病病史的胰腺结节病病例，该病例表现为胆道梗阻，酷似胰腺恶性肿瘤。我们还回顾了关于类似病例的管理和结果的文献。此处描述的患者表现出胰腺恶性肿瘤的所有体征和症状，CT扫描证实了这一点；正电子发射断层扫描和CA 19-9水平也证实了疑似诊断。在这种情况下，如果肿块看起来可切除，下一步合理的做法是进行胰十二指肠切除术。然而，对于一种可以通过改道而非切除手术缓解的良性疾病，这种策略将是激进的治疗方法，而且不会改变疾病的预后。我们建议，如果存在人口统计学一致性，对于有该疾病病史的患者保持高度怀疑。
