title: Pancreatic paracoccidioidomycosis simulating malignant neoplasia: case report.
abstract: Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus, and must be considered in the differential diagnosis of intra-abdominal tumors in endemic areas. We report a rare case of paracoccidioidomycosis in the pancreas. A 45-year-old man was referred to our institution with a 2-mo history of epigastric abdominal pain that was not diet-related, with night sweating, inappetence, weight loss, jaundice, pruritus, choluria, and acholic feces, without signs of sepsis or palpable tumors. Abdominal ultrasonography (US) showed a solid mass of approximately 7 cm × 5.5 cm on the pancreas head. Abdominal computerized tomography showed dilation of the biliary tract, an enlarged pancreas (up to 4.5 in the head region), with dilation of the major pancreatic duct. The patient underwent exploratory laparotomy, and the surgical description consisted of a tumor, measuring 7 to 8 cm with a poorly-defined margin, adhering to posterior planes and mesenteric vessels, showing an enlarged bile duct. External drainage of the biliary tract, Roux-en-Y gastroenteroanastomosis, lymph node excision, and biopsies were performed, but malignant neoplasia was not found. Microscopic analysis showed chronic pancreatitis and a granulomatous chronic inflammatory process in the choledochal lymph node. Acid-alcohol resistant bacillus and fungus screening were negative. Fine-needle aspiration of the pancreas was performed under US guidance. The smear was compatible with infection by Paracoccidioides brasiliensis. We report a rare case of paracoccidioidomycosis simulating a malignant neoplasia in the pancreas head.
authors.affiliation: Talles Bazeia Lima, Carlos Antonio Caramori, Giovanni Faria Silva, Cássio Vieira de Oliveira, Fábio da Silva Yamashiro, Letícia de Campos Franzoni, Lígia Yukie Sassaki, Fernando Gomes Romeiro, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, Rubião Junior District S/N, 18618-970 São Paulo, Brazil.
authors.forename: Talles Bazeia
authors.initials: TB
authors.lastname: Lima
authors.forename: Maria Aparecida Custódio
authors.initials: MA
authors.lastname: Domingues
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Caramori
authors.forename: Giovanni Faria
authors.initials: GF
authors.lastname: Silva
authors.forename: Cássio Vieira
authors.initials: CV
authors.lastname: de Oliveira
authors.forename: Fábio da Silva
authors.initials: Fda S
authors.lastname: Yamashiro
authors.forename: Letícia de Campos
authors.initials: Lde C
authors.lastname: Franzoni
authors.forename: Lígia Yukie
authors.initials: LY
authors.lastname: Sassaki
authors.forename: Fernando Gomes
authors.initials: FG
authors.lastname: Romeiro
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D010229:Paracoccidioidomycosis / Q000175:diagnosis*
keywords: Differential diagnosis; Fungus infection; Pancreas; Pancreatic tumors; Paracoccidioidomycosis
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