Fine-needle aspiration biopsy of an intra-abdominal inflammatory mass secondary to a penetrating duodenal ulcer mimicking neoplasm.
Peptic ulcers complicated by penetration into the surrounding tissue and presenting as an intra-abdominal mass simulating a malignancy are uncommon. We report on a case of a 56-yr-old physician with a 40-yr history of peptic disease. Due to recent and transitory right flank pain, an ultrasound then a computed tomography scan demonstrated a 4-cm retropancreatic mass. A fine-needle aspiration biopsy (FNAB) of the mass showed an acute and chronic inflammatory exudate. After a course of medical treatment for peptic ulcer disease and 5 mo after the biopsy, the mass remarkably decreased in size. In view of the clinical and FNAB findings, the lesion likely developed as a result of penetration of the duodenal ulcer into the retropancreatic space. Awareness of this uncommon complication of peptic gastroduodenal ulcer disease is helpful in the diagnosis of this benign lesion. A failure in making a firm diagnosis by considering the aspirate material as nonrepresentative may lead to an unnecessary repeat biopsy or an invasive procedure.
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St. Elizabeth Community Hospital, Department of Internal Medicine, Red Bluff, California, USA.
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D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000658:Amoxicillin / Q000627:therapeutic use; D001707:Biopsy, Needle; D017291:Clarithromycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000473:pathology*; D004382:Duodenitis / Q000188:drug therapy / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D016145:Endoscopy, Digestive System; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D064747:Lansoprazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole