Abstract
A patient 79-year-old male was regularly coming to his family physician for the treatment of diabetes since 12 years prior, when he had acute pancreatitis. Since Feb. of 2006 his diabetes got worse and then a tumor was found in the tail of pancreas by a CT study and was referred to our hospital. Tumor markers were all within normal range. Abdominal echo, CT and MRI studies revealed a tumor of 20mm in size in the tail of pancreas and dilatation of the distal main pancreatic duct. Possible malignancy could not be ruled out by image studies, and therefore a surgical intervention was performed. Laparotomy revealed an induration of 20mm in diameter with depression of the surface, tightly adhering to the transverse colon and mesocolon. Remaining part of the pancreas looked almost normal. Resection of the tail of the pancreas, splenectomy and partial resection of the transverse colon were performed. Postoperative pathohistological study revealed cholesterin crystals and foreign body giant cells surrounding cholesterin crystals at the center of the tumor and the diagnosis of cholesterin granuloma was made. Cholesterin granuloma is occasionally reported to arise in the liver, but the one confined in the pancreas is rare, and we could not find any other reported case in Japan.
