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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.


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Follow-up images acquired 10 months after the initiation of steroid therapy. (A and B) CT scan showing a low-attenuation mass measuring 2 cm at the pancreatic head (circle) and dilation of the MPD (arrow), which had not been observed in previous CT scans (Figs. 1 and 2). (C) Endoscopic retrograde cholangiopancreatography showing an ~2-cm long stricture of the MPD at the pancreatic head and dilatation of the the body and tail portion of MPD measuring 5 mm in diameter. (D) 18F-FDG-positron emission tomography/CT showing a well-circumscribed uptake of 18F-FDG at the location where the pancreatic head mass was identified by CT scan. CT, computed tomography; 18F-FDG, 18F-fluorodeoxyglucose; MPD, main pancreatic duct.
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f3-ol-0-0-4815: Follow-up images acquired 10 months after the initiation of steroid therapy. (A and B) CT scan showing a low-attenuation mass measuring 2 cm at the pancreatic head (circle) and dilation of the MPD (arrow), which had not been observed in previous CT scans (Figs. 1 and 2). (C) Endoscopic retrograde cholangiopancreatography showing an ~2-cm long stricture of the MPD at the pancreatic head and dilatation of the the body and tail portion of MPD measuring 5 mm in diameter. (D) 18F-FDG-positron emission tomography/CT showing a well-circumscribed uptake of 18F-FDG at the location where the pancreatic head mass was identified by CT scan. CT, computed tomography; 18F-FDG, 18F-fluorodeoxyglucose; MPD, main pancreatic duct.

Mentions: At 10 months after the initiation of the steroid therapy, elevated serum levels of amylase (255 IU/l; normal range, 37–124 IU/l) and lipase (91 IU/l; normal range, 13–49 IU/l) were detected, and a CT scan revealed a 2-cm low-attenuation mass at the pancreatic head and dilation of the MPD (Fig. 3A and B). The patient was readmitted to the hospital due to a suspected relapse of AIP. Magnetic resonance imaging (MRI) revealed tumor-like enlargement at the pancreatic head, and obstruction of the MPD with dilatation of the upstream MPD. ERCP showed a ~2-cm long stricture of the MPD at the pancreatic head and a dilatation of the body and tail portion of MPD that measured 5 mm in diameter (Fig. 3C). Based on these radiographic findings, it was difficult to decide between recurrence of AIP and pancreatic cancer. The serum levels of CA19-9, duke pancreatic monoclonal antigen type 2, and Span-1 were normal. The serum level of carcinoembryonic antigen was slightly elevated (7.1 ng/ml; normal range, <5.0 ng/ml). The serum level of IgG4 was 106 mg/dl, which was below the cutoff value (≥135 mg/dl) of the Japanese clinical diagnostic criteria for AIP (1). 18F-FDG-PET/CT (Aquiduo PCA-7000B; Toshiba Medical Systems, Ootawara, Japan) showed a well-circumscribed, solitary, nodular and homogenous 18F-FDG uptake, with a maximum standardized uptake value of 7.82 at the location where the pancreatic head mass was identified by CT scan (Fig. 3D). No abnormal extrapancreatic uptake of 18F-FDG was observed.


Localized 18 F-fluorodeoxyglucose uptake at the pancreatic head during remission phase of autoimmune pancreatitis: A case report
Follow-up images acquired 10 months after the initiation of steroid therapy. (A and B) CT scan showing a low-attenuation mass measuring 2 cm at the pancreatic head (circle) and dilation of the MPD (arrow), which had not been observed in previous CT scans (Figs. 1 and 2). (C) Endoscopic retrograde cholangiopancreatography showing an ~2-cm long stricture of the MPD at the pancreatic head and dilatation of the the body and tail portion of MPD measuring 5 mm in diameter. (D) 18F-FDG-positron emission tomography/CT showing a well-circumscribed uptake of 18F-FDG at the location where the pancreatic head mass was identified by CT scan. CT, computed tomography; 18F-FDG, 18F-fluorodeoxyglucose; MPD, main pancreatic duct.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-ol-0-0-4815: Follow-up images acquired 10 months after the initiation of steroid therapy. (A and B) CT scan showing a low-attenuation mass measuring 2 cm at the pancreatic head (circle) and dilation of the MPD (arrow), which had not been observed in previous CT scans (Figs. 1 and 2). (C) Endoscopic retrograde cholangiopancreatography showing an ~2-cm long stricture of the MPD at the pancreatic head and dilatation of the the body and tail portion of MPD measuring 5 mm in diameter. (D) 18F-FDG-positron emission tomography/CT showing a well-circumscribed uptake of 18F-FDG at the location where the pancreatic head mass was identified by CT scan. CT, computed tomography; 18F-FDG, 18F-fluorodeoxyglucose; MPD, main pancreatic duct.
Mentions: At 10 months after the initiation of the steroid therapy, elevated serum levels of amylase (255 IU/l; normal range, 37–124 IU/l) and lipase (91 IU/l; normal range, 13–49 IU/l) were detected, and a CT scan revealed a 2-cm low-attenuation mass at the pancreatic head and dilation of the MPD (Fig. 3A and B). The patient was readmitted to the hospital due to a suspected relapse of AIP. Magnetic resonance imaging (MRI) revealed tumor-like enlargement at the pancreatic head, and obstruction of the MPD with dilatation of the upstream MPD. ERCP showed a ~2-cm long stricture of the MPD at the pancreatic head and a dilatation of the body and tail portion of MPD that measured 5 mm in diameter (Fig. 3C). Based on these radiographic findings, it was difficult to decide between recurrence of AIP and pancreatic cancer. The serum levels of CA19-9, duke pancreatic monoclonal antigen type 2, and Span-1 were normal. The serum level of carcinoembryonic antigen was slightly elevated (7.1 ng/ml; normal range, <5.0 ng/ml). The serum level of IgG4 was 106 mg/dl, which was below the cutoff value (≥135 mg/dl) of the Japanese clinical diagnostic criteria for AIP (1). 18F-FDG-PET/CT (Aquiduo PCA-7000B; Toshiba Medical Systems, Ootawara, Japan) showed a well-circumscribed, solitary, nodular and homogenous 18F-FDG uptake, with a maximum standardized uptake value of 7.82 at the location where the pancreatic head mass was identified by CT scan (Fig. 3D). No abnormal extrapancreatic uptake of 18F-FDG was observed.

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