From Vrije Universiteit Medical Center, 1081 HV Amsterdam, the Netherlands.
Background: The work-up of patients with multiple tumors frequently provides evidence of metastatic disease.
Objective: We present the case of a patient with tumors in the brain, lung, and submandibular region after a previous pancreatic tumor who received a diagnosis of multifocal systemic fibrosis.
Case Report: A 66-year-old woman presented with a 2-week history of nausea, headache, and fever. Three years earlier, a Whipple procedure was performed for a pancreatic tumor. Pathologic examination had shown focal pancreatitis and fibrosis, but no malignant disease. At the current presentation, bilateral firm submandibular masses were noted. Cytologic examination of one of these masses was nonspecific, and histologic examination demonstrated glandular tissue with scattered areas of lymphoid infiltration and fibrosis. Because of right-sided hydronephrosis and a urine culture positive for Escherichia coli, the patient was treated with a nephrostomy drain and intravenous ceftriaxone, 2 g/d, without resolution of fever.
Published: Ann Intern Med. 2004;141(11):896-897.