Idiopathic tumefactive chronic pancreatitis: clinical profile, histology, and natural history after resection.
OBJECTIVE
Little is known about subjects with idiopathic tumefactive chronic pancreatitis (TCP), that is, chronic pancreatitis whose clinical presentation, usually with a mass or obstructive jaundice, suggests cancer.


METHODS
We independently reviewed clinical data and histology of 45 TCP (27 idiopathic, 18 alcohol induced) resected at Mayo Clinic (January 1985-March 2001). Follow-up data were obtained from medical records and mailed questionnaires.


RESULTS
Compared with alcoholic subjects, idiopathic TCP patients were older (58 +/- 2 vs. 48 +/- 3 yr, P < 0.001), had shorter symptom duration (median 3 vs. 24 wk, P < 0.001), were more likely to have no or mild abdominal pain (70% vs. 17%, P = 0.001), and were more often jaundiced (67% vs. 33%, P = 0.02). Three distinct histologic patterns were identified in TCP. Typical CP (n = 19) showed lobular atrophy, fat necrosis, and ductal changes (dilatation, protein plugs, and stones). Lymphoplasmacytic sclerosing pancreatitis (LPSP) (n = 14) was characterized by periductal lymphoplasmacytic infiltration, obliterative phlebitis, and cholangitis with edema. Idiopathic duct-centric CP (IDCP) (n = 12) had neutrophil-predominant lobular inflammation, without phlebitis. On correlation of clinical and histologic diagnosis, 17 of 18 (94%) patients with alcohol-induced TCP had typical CP, and 25 of 27 (93%) with idiopathic TCP had LPSP or IDCP. LPSP and IDCP were indistinguishable clinically except for higher incidence of jaundice in LPSP (93% vs. 42%, P = 0.005). In idiopathic TCP no recurrence of symptoms was observed after resection (median follow-up 49 mo).


CONCLUSIONS
Idiopathic TCP is clinically and histologically distinct from alcohol-induced TCP. It is unclear whether LPSP and IDCP, 2 unique patterns of histologic injury observed in idiopathic TCP, are part of the spectrum of the same disease or represent 2 or more different entities. Resection of mass prevents recurrence of symptoms in idiopathic TCP.
Yadav
Dhiraj
D
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Notahara
Kenji
K
Smyrk
Thomas C
TC
Clain
Jonathan E
JE
Pearson
Randall K
RK
Farnell
Michael B
MB
Chari
Suresh T
ST
D001652:Bile Ducts / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D003251:Constriction, Pathologic; D004108:Dilatation, Pathologic; D005218:Fat Necrosis / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010183:Pancreatic Ducts / Q000473:pathology; D010195:Pancreatitis / Q000145:classification / Q000473:pathology* / Q000601:surgery; D019512:Pancreatitis, Alcoholic / Q000473:pathology