title: Pancreatic mass as an initial manifestation of polyarteritis nodosa: a case report and review of the literature.
abstract: Classic polyarteritis nodosa (PAN) that targets medium-sized muscular arteries and microscopic polyangiitis (MPA), characterized by inflammation of small-caliber vessels and the presence of circulating myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA), are distinct clinicopathological entities of systemic vasculitis. A 66-year-old woman presented with fever, cholestasis and positive MPO-ANCA. Radiological examination showed a pancreatic mass compressing the bile duct. Therefore, we performed pancreatoduodenectomy. Histopathological examination revealed that necrotizing vasculitis predominantly affecting the medium-sized vessels, spared arterioles or capillaries in the pancreas, a finding consistent with PAN. Unexpectedly, renal biopsy revealed small-caliber vasculitis and glomerulonephritis, supporting MPA. The initial manifestation of a pancreatic mass associated with vasculitis has only been reported in 7 articles. Its diagnosis is challenging because no reliable clinico-radiological findings have been observed. Clinicians should be aware of such cases and early diagnosis followed by immunosuppression is mandatory. Our findings may reflect a polyangiitis overlap syndrome coexisting between pancreatic PAN and renal MPA.
authors.affiliation: Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yokoi
authors.affiliation: Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan.
authors.forename: Ippei
authors.initials: I
authors.lastname: Nakamura
authors.affiliation: Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Sawayanagi
authors.affiliation: Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Watahiki
authors.affiliation: Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005355:Fibrosis; D005921:Glomerulonephritis / Q000175:diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000276:immunology / Q000473:pathology; D055953:Microscopic Polyangiitis / Q000175:diagnosis / Q000276:immunology; D009336:Necrosis; D010179:Pancreas / Q000098:blood supply* / Q000187:drug effects / Q000276:immunology / Q000473:pathology / Q000601:surgery; D010182:Pancreatic Diseases / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D016577:Pancreaticoduodenectomy; D009195:Peroxidase / Q000276:immunology; D010488:Polyarteritis Nodosa / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D007166:Immunosuppressive Agents; D009195:Peroxidase
keywords: Classic polyarteritis nodosa; Microscopic polyangiitis; Myeloperoxidase anti-neutrophil cytoplasmic antibodies; Pancreatic mass; Polyangiitis overlap syndrome