Sarcoid involvement of the pancreas is uncommon and, when it happens, it may pose a challenge for radiologists and surgeons because, as in this case, it can be completely indistinguishable from pancreatic cancer. In the literature, pancreatic sarcoidosis has been described in two forms: diffusely nodular and a focal pancreatic mass, usually in the head of the pancreas ¹. 

The features found on the CT chest are not concerning for metastatic disease and would favor a granulomatous process, particularly the symmetrical hilar lymphadenopathy. 

With thanks to Dr Wa Cheung, Alfred Hospital, Melbourne, Australia.