Tumor of the tail of the pancreas as an unusual first manifestation of Wegener's disease

A fifty-year-old, previously healthy woman presented with abdominal pain and weight loss. Diagnostic work-up revealed a mass in the tail of the pancreas with the appearance of a pancreatic carcinoma. Partial pancreatectomy was performed. Postoperatively, the patient's kidney function deteriorated. Pathohistological examination of the resected tissue showed a granulomatous vasculitis but no maligant tumor. Renal biopsy revealed a rapid progressive glomerulonephritis. Positive C-ANCA screening confirmed the diagnosis of Wegener's disease and an immunosuppressive therapy was established. This case demonstrates the difficult management of a potentially benign pancreatic mass, as reliable discrimination from pancreatic adenocarcinoma is not always possible.