AJR:183, October 2004 915 Lymphoplasmacytic Sclerosing Pancreatitis with Obstructive Jaundice: CT and Pathology Features OBJECTIVE. The clinical presentation of lymphoplasmacytic sclerosing pancreatitis (LPSP) can be very similar to that of pancreatic cancer, with no statistically significant differences in the rates of abdominal pain, weight loss, jaundice, or levels of carcinoembryonic agent or cancer an- tigen 19-9. The purpose of this study is to describe and illustrate the CT features of LPSP present- ing with obstructive jaundice and to correlate CT and pathology findings. MATERIALS AND METHODS. Five patients with LPSP were evaluated. Morphologic features of the pancreas on CT scans, including the size of the pancreas, presence or absence of a mass, segmental difference of contrast enhancement, pancreatic duct, major pancreatic vasculature, and biliary tract, were retrospectively evaluated and correlated with histopathol- ogy. The degree of contrast enhancement of the pancreas was compared in 10 patients without LPSP, who were scanned with the same protocol. RESULTS. CT scans showed diffuse (n = 2) or focal (n = 3) enlargement of the pancreatic head. The normal lobular appearance of the pancreas was effaced, and the gland appeared fea- tureless in the involved region. Enlarged areas showed an enhancement pattern similar to that of the rest of the pancreas, and no segmental difference of contrast enhancement was identi- fied. Pancreatic duct dilatation was not seen in any patient. Thickening and contrast enhance- ment of the common bile duct wall (n = 4) and gallbladder wall (n = 3) were observed and were pathologically correlated with inflammatory infiltrate and fibrosis of the common bile duct (n = 3) and gallbladder (n = 1). CONCLUSION. When these findings are encountered, further evaluation with serologic tests or biopsy may aid in the diagnosis of LPSP. ancreaticoduodenectomy, also known as the Whipple procedure, is now a relatively safe procedure at centers of excellence with a low mortality rate and acceptable morbidity rate [1]. At leading centers, surgeons have espoused an aggressive approach to patients with putative periampullary malignancy, often eschewing biopsy before or during operation [2]. As a consequence, small numbers of patients (40/ 442 at Johns Hopkins [3], 29/603 at the Mayo Clinic [4], and 14/220 at the University of Amsterdam [5]) have Whipple procedures performed for benign disease that cannot be distinguished from cancer before surgery. Pancreatitis is the most common benign con- dition that mimics pancreatic cancer, and in recent experience at Johns Hopkins, lympho- plasmacytic sclerosing pancreatitis (LPSP) is the most common form of pancreatitis in patients who are subjected to pancreaticoduodenectomy for suspected cancer. LPSP is a distinctive form of chronic pan- creatitis characterized by a mixed inflamma- tory infiltrate that centers on the pancreatic ducts [3]. LPSP is also variously termed “nonalcoholic duct destructive chronic pan- creatitis” [6], “sclerosing pancreatitis” or “sclerosing pancreatic cholangitis,” and “au- toimmune pancreatitis” [7, 8]. The pathogen- esis of LPSP is unknown, but it is hypothesized to be a form of autoimmune pancreatitis. Yoshida et al. [7] reported unique features of this disorder, including in- creased serum γ-globulin, presence of au- toantibodies, absence of acute attacks of pancreatitis, diffuse enlargement of the pan- creas, and diffuse irregular narrowing of the main pancreatic duct on endoscopic retro- grade pancreatography. Occasional associa- Satomi Kawamoto 1 Stanley S. Siegelman 1 Ralph H. Hruban 2 Elliot K. Fishman 1 Received September 29, 2003; accepted after revision February 16, 2004. 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287. Address correspondence to S. Kawamoto (skawamo1@jhmi.edu). 2 Department of Pathology, Johns Hopkins Hospital, Baltimore, MD. AJR 2004;183:915–921 0361–803X/04/1834–915 © American Roentgen Ray Society P Downloaded from www.ajronline.org by 52.73.204.196 on 05/18/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved