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Autoimmune Pancreatitis: A Case of Atypical Radiographic Findings

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ABSTRACT

Autoimmune pancreatitis (AIP) is a rare pancreatic disorder that can present as a manifestation of a broader systemic inflammatory disease known as immunoglobulin G4-related systemic disease (IGG4-RSD). AIP is divided into two subtypes based on clinical, radiological, and histological findings. The disease can be mistaken for pancreatic cancer because of overlapping clinical and radiological findings, but early recognition can help avoid unnecessary surgery. We present a case of a 65-year-old female with suspected acute gallstone pancreatitis found to have AIP based on serology, radiological findings, and response to steroids.

No MeSH data available.


Related in: MedlinePlus

a Reactive duodenal mucosa with neutrophilic infiltration within epithelium and prominent chronic inflammation within lamina propria. Hematoxylin and eosin ×400. b Chronic inflammation composed of predominantly plasma cells with a high concentration of IgG4 cells. IgG4 immunostain ×400. Credit: Douglas J. Hartman, MD; Department of Pathology, University of Pittsburgh Medical Center.
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Figure 5: a Reactive duodenal mucosa with neutrophilic infiltration within epithelium and prominent chronic inflammation within lamina propria. Hematoxylin and eosin ×400. b Chronic inflammation composed of predominantly plasma cells with a high concentration of IgG4 cells. IgG4 immunostain ×400. Credit: Douglas J. Hartman, MD; Department of Pathology, University of Pittsburgh Medical Center.

Mentions: EUS and ERCP were done at which time pancreatic duct stricture (fig 3) and an oval mass were identified in the pancreas (fig 4). The mass was hypoechoic with poorly defined borders concerning for adenocarcinoma. Fine-needle aspiration/core biopsy as well as cytology and biopsy from the biliary stricture did not reveal any malignancy but did show 120 IgG4 cells per high-power field, with approximately 70% of the IgG cells being IgG4 (fig 5b). CA-19–9 was 19 U/ml (normal 0–35 U/ml), and ESR was elevated at 115 mm/h. The serum IgG level was noted to be 3,610 mg/dl (normal 700–1,600 mg/dl).


Autoimmune Pancreatitis: A Case of Atypical Radiographic Findings
a Reactive duodenal mucosa with neutrophilic infiltration within epithelium and prominent chronic inflammation within lamina propria. Hematoxylin and eosin ×400. b Chronic inflammation composed of predominantly plasma cells with a high concentration of IgG4 cells. IgG4 immunostain ×400. Credit: Douglas J. Hartman, MD; Department of Pathology, University of Pittsburgh Medical Center.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC5121540&req=5

Figure 5: a Reactive duodenal mucosa with neutrophilic infiltration within epithelium and prominent chronic inflammation within lamina propria. Hematoxylin and eosin ×400. b Chronic inflammation composed of predominantly plasma cells with a high concentration of IgG4 cells. IgG4 immunostain ×400. Credit: Douglas J. Hartman, MD; Department of Pathology, University of Pittsburgh Medical Center.
Mentions: EUS and ERCP were done at which time pancreatic duct stricture (fig 3) and an oval mass were identified in the pancreas (fig 4). The mass was hypoechoic with poorly defined borders concerning for adenocarcinoma. Fine-needle aspiration/core biopsy as well as cytology and biopsy from the biliary stricture did not reveal any malignancy but did show 120 IgG4 cells per high-power field, with approximately 70% of the IgG cells being IgG4 (fig 5b). CA-19–9 was 19 U/ml (normal 0–35 U/ml), and ESR was elevated at 115 mm/h. The serum IgG level was noted to be 3,610 mg/dl (normal 700–1,600 mg/dl).

View Article: PubMed Central - PubMed

ABSTRACT

Autoimmune pancreatitis (AIP) is a rare pancreatic disorder that can present as a manifestation of a broader systemic inflammatory disease known as immunoglobulin G4-related systemic disease (IGG4-RSD). AIP is divided into two subtypes based on clinical, radiological, and histological findings. The disease can be mistaken for pancreatic cancer because of overlapping clinical and radiological findings, but early recognition can help avoid unnecessary surgery. We present a case of a 65-year-old female with suspected acute gallstone pancreatitis found to have AIP based on serology, radiological findings, and response to steroids.

No MeSH data available.


Related in: MedlinePlus