Novel EUS features of AIP are useful in distinguishing AIP from PC and for following the effects of steroid therapy.

REG4 is expressed in pancreatic cancer, and serum levels of REG4 offer a useful indicator for distinguishing between patients with pancreatic cancer and healthy subjects. Serum REG4 has potential for use as a screening serum marker for pancreatic cancers, including early-stage cancers.

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A-77-year-old-woman was referred to our hospital because of dilatation of the main duct in the pancreatic body, as seen on transabdominal ultrasonography. The patient had experienced several episodes of acute pancreatitis in the previous 2 years. Laboratory tests showed mild anemia (hemoglobin 11.7 g/dL; reference range: 12-16 g/dL). Levels of serum amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9 were within normal limits. Computed tomography and magnetic resonance cholangiopancreatography revealed mild dilatation of the main pancreatic duct and demonstrated lack of a mass lesion. Endoscopic retrograde cholangiopancreatography (ERCP) showed stricture of the main duct in the head of the pancreas (• " Fig. 1). Cytological analysis of the pancreatic juice showed no malignancy. During ERCP, a side-viewing upper endoscope showed blood oozing from the major papilla (• " Fig. 2). Bleeding was intermittent and stopped after ERCP. Endoscopic ultrasonography (EUS) showed a small vague hypoechoic area adjacent to the stenotic duct of the pancreas. These findings led to a clinical diagnosis of pancreatic cancer at an early stage, and pancreatic duodenectomy was performed. Histopathological examination showed intraductally spreading carcinoma in the main and branch duct of the