Xanthogranulomatous pancreatitis is uncommon but important to recognize, since it may be mistaken for a pancreatic neoplasm on imaging studies.


Findings on imaging studies:

(1) low density solid (non-cystic) mass in the pancreas

(2) hyperintense on T2-weighted images

(3) isointense on T1-weighted images

(4) variable peripancreatic fibrosis


Pathologic features:

(1) chronic inflammation with a mixed inflammatory cell infiltrate

(2) numerous macrophages, many of which are foamy and lipid-laden

(3) macrophages are CD68 positive but negative for S100


Differential diagnosis:

(1) chronic pancreatitis

(2) pseudotumor

(3) extranodal Rosai-Dorfman disease

(4) Tangier disease or other metabolic storage disease


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