Pancreatic mass as an initial manifestation of polyarteritis nodosa: A case report and review of the literature

Table 1 Reported cases of pancreatic tumor associated with vasculitis

Ref.	Age/sex/race etc.	Finaldiagnosis	Symptoms	Sitesinvolved	Prior diagnosis	Tumor sizeimaging findings	Diagnostic criteria	Outcome
								Pancreas	Patient
Ito et al[11]	44/M/ Japanese	Localized PAN	Epigastralgia	Head	No	ND ERCP: CBD stenosis	ND	Underwent PD	Discharged
O'Neil et al[8]	62/M/ White	GPA	Jaundice Otitis media Nasal ulceration	Head Gallbladder	No	3 cm CT: mass US: hypoechoic ERCP: CBD stenosis	ANCA (+) Needle biopsy: non diagnostic Renal biopsy: confirmed	Improved on CYC + CS	Improved on CYC + CS
Damani et al[5]	46/F/ ND	PAN	Right upper abdominal pain	Neck	No	2 cm US: hypoechoic CT: low attenuation, nonenhancing mass	Needle biopsy: non diagnostic Postoperative histopathology	Cholecystectomy Distal Px	Died (20 d) Various complication
Kariv et al[6]	65/ M/ Jewish	PAN	Epigastralgia Weight loss Low grade fever	Head	No	3 cm CT: mass	Needle biopsy: chronic pancreatitis	Underwent PD	Remission on CS
Matsubayashi et al[9]	65/M/ Japanese	GPA	Left abdominal pain Constipation Low grade fever Tympanitis	Body and Tail	S/O GPA	ND CT: Enlargement of pancreas with sporadic low density lesions	12PR3-ANCA (+) Autopsy	No	Died Hemorrhagic pneumonia Diffuse necrotizing pancreatitis
Tinazzi et al[10]	48/F/ ND	GPA	Mid-epigastric pain	Head	No	2 cm: US: Hypoechoic MRCP: Obstruction of pancreatic duct	Postoperative histopathology	Underwent PD	Improved on CYC + CS
Gonzalez-Gay et al[12]	75/M/ White	Localized PAN	Epigastralgia	Head	No	ND	Postoperative histopathology	Underwent PD	Discharged
Our case	66 /F/ Japanese	PAN Renal MPA	Otitis media Fever	Head Gallbladder Bile duct Duodenum	No	2 cm US: Hypoechoic CT: Hypodense Non-enhancing	MPO-ANCA(+) Postoperative histopathology	Underwent PD	Improved on CYC + CS Discharged

PAN: Polyarteritis nodosa; ERCP: Endoscopic retrograde cholangiopancreatography; CBD: Common bile duct; PD: Pancreatoduodenectomy; GPA: Granulomatosis with polyangiitis; US: Ultrasonography; ANCA: Anti-neutrophil cytoplasmic antibody; CYC: Cyclophosphamide; CS: Corticosteroids; Px: Pancreatectomy; S/O: Suspect of; PR3: Proteinase 3; MRCP: Magnetic resonance cholangiopancreatography; MPA: Microscopic polyangiitis; MPO: Myeloperoxidase.