Groove Pancreatitis or Pancreatic Neoplasm: A Surgical Dilemmas

Eugenio Morandi^1, , Marco Castoldi¹, Carlo Corbellini¹, Michela Monteleone¹, David Alessio Merlini¹, Gianandrea Vignati¹ and Paolo Declich²

¹General Surgery Department, "G. Salvini" Hospital of Rho – Milan, Italy

²Anatomopathological Department, "G. Salvini" Hospital of Rho – Milan, Italy

Cite this paper

Eugenio Morandi, Marco Castoldi, Carlo Corbellini, Michela Monteleone, David Alessio Merlini, Gianandrea Vignati and Paolo Declich. Groove Pancreatitis or Pancreatic Neoplasm: A Surgical Dilemmas. American Journal of Medical Case Reports. 2014; 2(12):298-302. doi: 10.12691/AJMCR-2-12-10

Abstract

Background: Groove pancreatitis (GP) is a rare condition characterized by inflammatory fibrosis of the space between the dorsal-cranial part of the head of the pancreas, duodenum and common bile duct. Surgery is often the choice of treatment. Case report: A 44-year-old male patient with a history of a high alcoholic intake came with epigastric pain associated with a weight loss. An abdominal ultrasonography, a computer tomography (CT) and a gastro-duodenoscopy showed a mass of the pancreatic head with duodenal infiltration suggesting for adenocarcinoma of the pancreas. An endoscopic ultrasound - fine needle aspiration (EUS-FNA) did not show any sign of chronic inflammation. The patient underwent Whipple procedure. Histologic examination confirmed chronic inflammation in the groove area with a ruptured pancreatic-type cyst and some pseudocysts in depth of the wall. Conclusion: The diagnosis of GP is challenging. Radiological and endoscopic findings and symptoms are often not specific and they could also be present in patients with adenocarcinoma of the pancreas. The pancreaticoduodenectomy is often the choice of treatment when symptoms do not improve or when there is uncertainty over the diagnosis.

Keywords

pancreatic neoplasm, pancreatitis, chronic pancreatitis, groove pancreatitis

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Potet F, Duclert N. Dystrophie kystique sur pancreas aberrant de la paroi duodenale. Arch F Mal App Dig 1970; 59: 223-38.
[2]	McFaul CD, Vitone LJ, Campbell F, Azadeh B, Hughes ML, Garvey CJ et al. Pancreatic hamartoma. Pancreatology 2004; 4: 533-8.
[3]	Ryan A, Lafnitzegger JR, Lin DH, Jakate S, Staran ED. Myoepithelial hamartoma of the duodenal wall. Virchows Arch 1998; 432: 191-4.
[4]	Becker V. Bauchepeicheldrüse. In: Doerr W, Seifert G, Ühlinger E, Eds. Spezielle Pathologische Anatomie, Chap 6. Berlin, Germany: Springer, 1973: 252-445.
[5]	Stolte M, Weiss W, Volkholz H, Rosch W. A special form of segmental pancreatitis: ''groove pancreatitis''. Hepatogastroenterology 1982; 29: 198-208.
[6]	Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying ''cystic dystrophy of heterotopic pancreas'', ''para-duodenal wall cyst'' and ''groove pancreatitis''. Semin Diagn Pathol 2004; 21: 247-54.
[7]	Becker V, Mischke U. Groove pancreatitis. Int J Pancreatol 1991; 10: 173-182.
[8]	Shudo R, Obara T, Tanno S, Fujii T, Nishino N, Sagawa M, Ura H et al. Segmental groove pancreatitis accompanied by protein plugs in Santorini's duct. J Gastroenterol 1998; 33: 289-294.
[9]	Koji Tezuka, Takatoshi Makino, Ichiro Hirai, Wataru Kimura. Groove Pancreatitis. Dig Surg 2010; 27: 149-152.
[10]	Irie H, Honda H, Kuroiwa T, Hanada K, Yoshimitsu K, Tajima T et al. MRI of groove pancreatitis. J Comput Assist Tomogr 1998; 22: 651-5.
[11]	Itoh S, Yamakawa K, Shimamoto K, Endo T, Ishigaki T. CT findings in groove pancreatitis: correlation with histopathological findings. J Comput Assist Tomogr 1994; 18: 911-5.
[12]	Zamboni G, Capelli P, Scarpa A, Bogina G, Pesci A, Brunello E, Klöppel G: Nonneoplastic mimickers of pancreatic neoplasms. Arch Pathol Lab Med 2009; 133: 439-453.
[13]	Balakrishnan V, Chatni S, Radhakrishnan L, Narayanan VA, Nair P: Groove pancreatitis: a case report and review of literature. JOP 2007; 8: 592-597.
[14]	Shudo R, Yazaki Y, Sakurai S, Uenishi H, Yamada H, Sugawara K et al. Groove pancreatitis: report of a case and review of the clinical and radiologic features of groove pancreatitis reported in Japan. Intern Med 2002; 41: 537-42.
[15]	Yamaguchi K, Tanaka M. Groove pancreatitis masquerading as pancreatic carcinoma. Am J Surg 1992; 163: 312-6.
[16]	Gabata T, Kadoya M, Terayama N, Sanada J, Kobayashi S, Matsui O. Groove pancreatic carcinomas: radiological and pathological findings. Eur Radiol 2003; 13: 1679-84.
[17]	Marek Wronski, Dominika Karkocha, Maciej Slodkowski, Wlodzimierz Cebulski, Ireneusz W. Krasnodebski, Sonographic Findings in Groove Pancreatitis. J Ultrasound Med 2011; 30: 111-115.
[18]	Rahman SH, Verbeke CS, Gomez D, McMahon MJ, Menon KV. Pancreatico-duodenectomy for complicated groove pancreatitis. HPB (Oxford) 2007; 9: 229-234.
[19]	Sanada Y, Yoshida K, Itoh H, Kunita S, Jinushi K, Matsuura H. Groove pancreatitis associated with true pancreatic cyst. J Hepatobiliary Pancreat Surg 2007; 14: 401-9.
[20]	Fujita N, Shirai Y, Tsukada K, Kurosaki I, Iiai T, Hatakeyama K. Groove pancreatitis with recurrent duodenal obstruction. Report of a case successfully treated with pylorus-preserving pancreaticoduodenectomy. Int J Pancreatol 1997; 21: 185-8.
[21]	Mohl W, Hero-Gross R, Feifel G, Kramann B, Puschel W, Menges M et al. Groove pancreatitis: an important differential diagnosis to malignant stenosis of the duodenum. Dig Dis Sci 2001; 46: 1034-8.
[22]	Tio TL, Luiken GJ, Tytgat GN. Endosonography of groove pancreatitis. Endoscopy 1991; 23: 291-3.
[23]	Balakrishnan V, Chatni S, Radhakrishnan L, Narayanan VA, Nair P. Groove pancreatitis: a case report and review of literature. JOP 2007; 8: 592-597.
[24]	Tan CH, Chow PK, Thng CH, Chung AY, Wong WK. Pancreatic adenocarcinoma that mimics groove pancreatitis: case report of a diagnostic dilemma. Dig Dis Sci 2006; 51: 1294-6.
[25]	Levenick JM, Gordon SR, Sutton JE, Suriawinata A, Gardner TB. A comprehensive, casebased review of groove pancreatitis. Pancreas 2009; 38: e169-e175.
[26]	Isayama H, Kawabe T, Komatsu Y, Sasahira N, Toda N, Tada M et al. Successful treatment for groove pancreatitis by endoscopic drainage via the minor papilla. Gastrointest Endosc 2005; 61:175-178.
[27]	Antonio Manzelli, Athanasios Petrou, Alesandra Lazzaro, Nicholas Brennan, Zahir Soonawalla, Peter Friend, Groove Pancreatitis. A Mini-Series Report and Review of the Literature; JOP. J Pancreas (Online) 2011; 12(3): 230-233.
[28]	Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M et al. ‘Paraduodenal' pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2009; 33: 2664-2669.
[29]	Egorov VI, Butkevich AC, Sazhin AV, Yashina NI, Bogdanov SN. Pancreas-preserving duodenal resections with bile and pancreatic duct replantation for duodenal dystrophy. Two case reports. JOP 2010; 11: 446-452.