Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Department of Pathology, Chonnam National University Medical School, Gwangju, Korea.
Medicine (Baltimore). 2023 Feb 3;102(5):e32837. doi: 10.1097/MD.0000000000032837.
Follicular pancreatitis is a very rare type of focal chronic pancreatitis and is often mistaken for pancreatic neoplasms. It is histologically characterized by extensive lymphoid follicular formation with reactive germinal centers.
A 50-year-old man was admitted to our hospital with 1-month history of epigastric pain. Contrast-enhanced computed tomography and magnetic resonance imaging revealed a 4.7 cm sized enhancing pancreatic head mass with anterior mesenteric soft tissue infiltration and superior mesenteric vein invasion. Endoscopic ultrasonography revealed an ill-defined hypoechoic mass in the head of the pancreas.
A laparoscopic surgical biopsy was performed. Hematoxylin-eosin staining showed the acini structure destruction within the pancreatic parenchyma and different-sized lymphoid follicles with reactive germinal centers around the duct. Immunohistochemical examination showed that cells were positive for the B-cell marker CD20, T-cell marker CD3, and slightly positive for IgG4. However, cells were negative for the B-cell marker Bcl-2. Follicular pancreatitis was confirmed based on the findings of histology and immunohistochemistry.
The patient was regularly followed without any specific treatment.
Follow-up computed tomography revealed no change in the lesion 1 year after diagnosis.
To the best of our knowledge, this is the first case of follicular pancreatitis in Korea.
滤泡性胰腺炎是一种非常罕见的局灶性慢性胰腺炎，常被误诊为胰腺肿瘤。其组织学特征为广泛的淋巴滤泡形成伴有反应性生发中心。
一名 50 岁男性因上腹痛 1 个月入院。增强 CT 和 MRI 显示胰头部有一个 4.7cm 大小的强化肿块，伴有前肠系膜软组织浸润和肠系膜上静脉侵犯。超声内镜显示胰头部有一个边界不清的低回声肿块。
进行了腹腔镜手术活检。苏木精-伊红染色显示胰腺实质内腺泡结构破坏，伴有不同大小的淋巴滤泡，周围有导管反应性生发中心。免疫组化检查显示细胞对 B 细胞标志物 CD20、T 细胞标志物 CD3 呈阳性，对 IgG4 呈弱阳性，但对 B 细胞标志物 Bcl-2 呈阴性。根据组织学和免疫组化检查结果确诊为滤泡性胰腺炎。
患者定期随访，未进行特殊治疗。
诊断 1 年后的 CT 随访显示病变无变化。
据我们所知，这是韩国首例滤泡性胰腺炎病例。
