Obstructive Jaundice due to Pancreatic Sarcoidosis

Purpose: Gastrointestinal involvement occurs in 0.1-0.9% of patients with sarcoidosis, being the liver and stomach the most affected organs. Pancreatic sarcoidosis is rare and usually asymptomatic. We herein report a case of a patient with a suspected pancreatic head neoplasia in whom, after performing a pancreaticoduodenectomy, presented a pancreatic sarcoidosis. Method: 61-year-old female with personal history of diabetes and sarcoidosis with lung, skin, and articular involvement. Patient started with obstructive jaundice with no other symptoms. A malignant stenosis of the common bile duct was observed by echoendoscopy and a covered metal stent was inserted using an endoscopic retrograde cholangiographic technique. Histological study after fine needle aspiration were suspected of neoplasia. A CT scan showed no evidence of invasion of surrounding organs, vessels, or lymph nodes. Surgical treatment was proposed due to a suspected pancreatic head neoplasia. Result: A tumor located in the pancreatic head was observed during surgical intervention. No signs of extrapancreatic extension were appreciated. A pancreaticoduodenectomy with inter-aorto-caval and hepatic hilum lymph-node dissection was performed. Subsequent reconstruction con pancreatojejunostomy, hepaticojejunostomy and gastrojejunostomy was made. After surgery, patient presented gastroparesis that required insertion of a nasogastric tube. Histology exam revealed the presence of a non-necrotizing granulomatous inflammatory reaction in the specimen with no tumor. With this findings diagnosis of pancreatic sarcoidosis was made. Conclusion: Pancreatic sarcoidosis may present as a tumor-like mass with obstructive jaundice, weight loss, and abdominal pain as main symptoms. Differential diagnosis of an inflammatory mass from a tumor mass is difficult in theses cases.