Groove Pancreatitis: A Malignant Masquerade in the DuodenumKarin Eshagh1, Chris M Reid1,2, Michael Chan1,3, Grace Y Lin1,4, Thomas Savides1,3 and Jason K Sicklick1,2*
- *Corresponding Author:
- Jason K. Sicklick
Division of Surgical Oncology
University of California, 3855 Health Sciences Drive
Room 2313, La Jolla, CA 92093-0987, USA
E-mail: [email protected]
Received date: June 27, 2014; Accepted date: September 18, 2014; Published date: September 25, 2014
Citation: Eshagh K, Reid C, Chan M, Lin G, Savides T, et al. (2014) Groove Pancreatitis: A Malignant Masquerade in the Duodenum. J Gastroint Dig Syst 4:217. doi:10.4172/2161-069X.1000217
Copyright: © 2014 Eshagh K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Groove pancreatitis is a rare form of chronic pancreatitis that has been described by several names including para-duodenal wall cyst, pancreatic hamartoma of the duodenum, cystic dystrophy of heterotopic pancreas, and myoadenomatosis. It is characterized microscopically by the presence of a pseudocyst arising from the “groove” between the duodenum, common bile duct, and pancreatic head. It is thought to be caused by functional and/or anatomical minor papilla obstruction from viscous pancreatic secretions. In turn, this leads to impaired pancreatic enzyme outflow, Brunner’s gland proliferation, and resultant pancreatitis. This often appears as a submucosal mass in the region. Thus, the differential diagnosis ranges from benign pathologies such as Brunner’s gland hyperplasia, leiomyoma, and schwannoma to malignant pathologies such as gastrointestinal stromal tumor and ampullary carcinoma. Herein, we present a case of a middle aged male smoker with a remote history of alcohol abuse that presented with one month of epigastric pain associated with bilious emesis and weight loss. Computed tomography (CT) and endoscopic ultrasound (EUS) revealed a submucosal cystic mass that was obstructing the second portion of the duodenum. Cytology demonstrated crowded groups of atypical epithelioid and spindle cells that were suspicious for a neoplasm. The patient subsequently underwent pancreaticoduodenectomy in order to relieve his duodenal obstruction, as well as to establish a definitive tissue diagnosis. Despite the use of multiple imaging modalities including CT and EUS with fine needle aspirates, the final diagnosis of groove pancreatitis was only made following resection. This case now demonstrate that groove pancreatic often mimics submucosal duodenal tumors and malignant periampullary cancers clinically, radiographically, endoscopically, and cytologically.