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Localized 18 F-fluorodeoxyglucose uptake at the pancreatic head during remission phase of autoimmune pancreatitis: A case report

View Article: PubMed Central - PubMed

ABSTRACT

Autoimmune pancreatitis (AIP) is a unique form of pancreatitis, histopathologically characterized by dense lymphoplasmacytic infiltration and fibrosis of the pancreas with obliterative phlebitis. AIP is associated with a good response to steroid therapy. Differentiation between AIP and pancreatic cancer to determine a preoperative diagnosis is often challenging, despite the use of various diagnostic modalities, including computed tomography (CT), magnetic resonance imaging and endoscopic retrograde cholangiopancreatography. It has been reported that 18F-fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)/CT may be a useful tool for distinguishing between the two diseases. In the present case report, a 71-year-old male patient presented with a well-circumscribed, solitary, nodular and homogenous 18F-FDG uptake at the pancreatic head, while receiving maintenance steroid therapy in the remission phase of AIP; preoperatively, the patient had been strongly suspected of having pancreatic cancer. Pathological examination revealed post-treatment relapse of AIP. The present case highlights the diagnostic and management difficulties with AIP in the remission phase. In certain cases, it remains challenging to differentiate the two diseases, even using the latest modalities.

No MeSH data available.


Related in: MedlinePlus

Follow-up images acquired 3 months after the initiation of steroid therapy. (A and B) Computed tomography showing that the enlargement of the pancreatic head (circle) and body had markedly improved. (C) Endoscopic retrograde cholangiopancreatography showing that the diffuse narrowing of the main pancreatic duct had fully recovered.
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f2-ol-0-0-4815: Follow-up images acquired 3 months after the initiation of steroid therapy. (A and B) Computed tomography showing that the enlargement of the pancreatic head (circle) and body had markedly improved. (C) Endoscopic retrograde cholangiopancreatography showing that the diffuse narrowing of the main pancreatic duct had fully recovered.

Mentions: The initial oral prednisolone dose administered was 30 mg/day. Following the initiation of the steroid therapy, the enlargement of the pancreatic head and body markedly improved, the diffuse narrowing of the MPD fully recovered (Fig. 2A-C), and the IgG4 level dropped to within normal limits. The oral steroid therapy regimen was as follows: The initial dose was administered daily for 2 weeks, followed by gradual tapering of the dose by 5 mg every 2 weeks, until a daily dose of 5 mg was reached. Subsequently, maintenance steroid therapy (5 mg/day) was administered, based on the Japanese consensus guidelines for the management of AIP (6). Follow-up examinations were performed on an outpatient basis.


Localized 18 F-fluorodeoxyglucose uptake at the pancreatic head during remission phase of autoimmune pancreatitis: A case report
Follow-up images acquired 3 months after the initiation of steroid therapy. (A and B) Computed tomography showing that the enlargement of the pancreatic head (circle) and body had markedly improved. (C) Endoscopic retrograde cholangiopancreatography showing that the diffuse narrowing of the main pancreatic duct had fully recovered.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998295&req=5

f2-ol-0-0-4815: Follow-up images acquired 3 months after the initiation of steroid therapy. (A and B) Computed tomography showing that the enlargement of the pancreatic head (circle) and body had markedly improved. (C) Endoscopic retrograde cholangiopancreatography showing that the diffuse narrowing of the main pancreatic duct had fully recovered.
Mentions: The initial oral prednisolone dose administered was 30 mg/day. Following the initiation of the steroid therapy, the enlargement of the pancreatic head and body markedly improved, the diffuse narrowing of the MPD fully recovered (Fig. 2A-C), and the IgG4 level dropped to within normal limits. The oral steroid therapy regimen was as follows: The initial dose was administered daily for 2 weeks, followed by gradual tapering of the dose by 5 mg every 2 weeks, until a daily dose of 5 mg was reached. Subsequently, maintenance steroid therapy (5 mg/day) was administered, based on the Japanese consensus guidelines for the management of AIP (6). Follow-up examinations were performed on an outpatient basis.

View Article: PubMed Central - PubMed

ABSTRACT

Autoimmune pancreatitis (AIP) is a unique form of pancreatitis, histopathologically characterized by dense lymphoplasmacytic infiltration and fibrosis of the pancreas with obliterative phlebitis. AIP is associated with a good response to steroid therapy. Differentiation between AIP and pancreatic cancer to determine a preoperative diagnosis is often challenging, despite the use of various diagnostic modalities, including computed tomography (CT), magnetic resonance imaging and endoscopic retrograde cholangiopancreatography. It has been reported that 18F-fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)/CT may be a useful tool for distinguishing between the two diseases. In the present case report, a 71-year-old male patient presented with a well-circumscribed, solitary, nodular and homogenous 18F-FDG uptake at the pancreatic head, while receiving maintenance steroid therapy in the remission phase of AIP; preoperatively, the patient had been strongly suspected of having pancreatic cancer. Pathological examination revealed post-treatment relapse of AIP. The present case highlights the diagnostic and management difficulties with AIP in the remission phase. In certain cases, it remains challenging to differentiate the two diseases, even using the latest modalities.

No MeSH data available.


Related in: MedlinePlus