Auto immune pancreatitis
(AIP) is an uncommon form of chronic pancreatitis that has been divided into type 1 and type 2 which have distinct
histopathology and clinical features. Type 1 AIP seems to be the pancreatic
manifestation of an IgG4-related systemic disease, characterized by elevated
IgG4 serum levels, infiltration of IgG4-positive plasma cells and extrapancreatic
lesions. When manifesting as a focal disease in the pancreas, it can be
challenging to differentiate it from pancreatic cancer (PC). Because AIP is
typically responsive to steroid therapy without the need for resection,
differentiation between these two diseases is critical. We report the case of a
56-year-old man with initial suspect of PC, and final diagnosis of type 1 AIP
according to the International Consensus Diagnostic Criteria (ICDC) without
elevated levels of serum IgG4 or need for a histology sample. We take a review
of literature in order to improve the diagnostic accuracy of AIP and describe
clinical and imaging features to differentiate it from PC and avoid unnecessary
surgery due to misdiagnosis.
References
[1]
Franchello, A., Gonella, F., Campra, D., Limerutti, G., Bruno, M., De Angelis, C., et al. (2014) A Rare Case of IgG4-Related Systemic Disease Manifesting with Pancreatic Head Mass Mimicking Borderline Resectable Cancer. International Journal of Surgery Case Reports, 5, 1095-1097. https://doi.org/10.1016/j.ijscr.2014.11.014
[2]
Crosara, S., D’Onofrio, M., De Robertis, R., Demozzi, E., Canestrini, S., Zamboni, G. and Pozzi Mucelli, R. (2014) Autoimmune Pancreatitis: Multimodality Non-Invasive Imaging Diagnosis. World Journal of Gastroenterology, 20, 16881-16890.
https://doi.org/10.3748/wjg.v20.i45.16881
[3]
Li, Y.Q. and Xiong, X.J. (2017) Clinically Mimicking Pancreatic and Dilation in Main Pancreatic Duct in Autoimmune Pancreatitis (AIP): A Case Report and Literature Review. Open Access Library Journal, 4, e3065.
[4]
Takuma, K., Kamisawa, T., Gopalakrishna, R., Hara, S., Tabata, T., Inaba, Y., Egawa, N. and Igarashi, Y. (2012) Strategy to Differentiate Autoimmune Pancreatitis from Pancreas Cancer. World Journal of Gastroenterology, 18, 1015-1020.
[5]
Kamisawa, T., Chen, P.Y., Tu, Y., Nakajima, H., Egawa, N., Tsuruta, K., Okamoto, A. and Hishima, T. (2006) Pancreatic Cancer with a High Serum IgG4 Concentration. World Journal of Gastroenterology, 12, 6225-6228.
http://www.wjgnet.com/1007-9327/12/6225.asp
[6]
Sun, G.F., Zuo, C.J., Shao, C.W., Wang, J.H. and Zhang, J. (2013) Focal Autoimmune Pancreatitis: Radiological Characteristics Help to Distinguish from Pancreatic Cancer. World Journal of Gastroenterology, 19, 3634-3641.
https://doi.org/10.3748/wjg.v19.i23.3634
[7]
Nakano, E., Kanno, A., Masamune, A., Yoshida, N., Hongo, S., Miura, S., Takikawa, T., Hamada, S., Kume, K., Kikuta, K., Hirota, M., Nakayama, K., Fujishima, F. and Shimosegawa, T. (2015) IgG4-Unrelated Type 1 Autoimmune Pancreatitis. World Journal of Gastroenterology, 21, 9808-9816.
https://doi.org/10.3748/wjg.v21.i33.9808
[8]
Levy, M.J., Wiesema, M.J. and Chari, S.T. (2006) Chronic Pancreatitis: Focal Pancreatitis or Cancer? Is There a Role for FNA/Biopsy? Autoimmune Pancreatitis. Endoscopy, 38, 30-35. https://doi.org/10.1055/s-2006-946648
