Focal IgG4-related autoimmune pancreatitis with distal choledochal adenocarcinoma: a rare case report

Abstract

Background Autoimmune pancreatitis (AIP) is a rare disease that manifests as pancreatic involvement in systemic IgG4-related disease (IgG4-RD), a special type of chronic pancreatitis caused by autoimmune abnormalities. The main imaging manifestations of IgG4-related AIP consist of diffuse or localized pancreatic enlargement and irregular pancreatic duct narrowing. The diagnosis of AIP is challenging because it can present with focal lesions, similar to radiologically bile duct cancer or pancreatic cancer. Case presentation A 55-year-old male patient was admitted with painless jaundice and multiple radiographic findings of pancreatic head mass, as well as intrahepatic and extrahepatic bile duct dilatation. Various imaging methods indicated pancreatic cancer. However, the endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) and a laparoscopic pancreatic biopsy suggested an IgG4-related AIP. After one month, magnetic resonance imaging showed that the lesion had slightly grown. Combined with CA19-9 and other indexes, the possibility of malignancy was high and there were still surgical indications. The pathological analysis following a pancreaticoduodenectomy revealed poorly differentiated adenocarcinoma in the distal common bile duct. Conclusion To date, few reports have described pancreatic or extrapancreatic malignancies in AIP patients, and no association between AIP and bile duct adenocarcinoma has been previously confirmed. This case discuss the differentiation between AIP and malignancy, recent research progress, and the correlation between the two diseases, highlights the importance of carefully evaluating patients with AIP to rule out potential tumors, as well as the critical need for follow up treatment.

Primary pancreatic peripheral T‐cell lymphoma‐not otherwise specified mimicking acute pancreatitis: A case report and review of literature

“…Though there is a similarity between the symptoms and the imaging findings, some clues exist to differentiate them 1,24 . Serological alterations, histological characteristics, such as lymphocyte infiltration and pancreatic interstitial fibrosis, and imaging findings, including pancreatic enlargement and irregular constriction of the major pancreatic duct, are all linked with autoimmune pancreatitis 25 . However, PPL suspicion is based on a CT scan showing pancreatic bulky, homogeneous, and poor enhancing lesions as opposed to adenocarcinoma 1,15,26,27 .…”

“…1,24 Serological alterations, histological characteristics, such as lymphocyte infiltration and pancreatic interstitial fibrosis, and imaging findings, including pancreatic enlargement and irregular constriction of the major pancreatic duct, are all linked with autoimmune pancreatitis. 25 However, PPL suspicion is based on a CT scan showing pancreatic bulky, homogeneous, and poor enhancing lesions as opposed to adenocarcinoma. 1,15,26,27 The vascular encasement is prevalent in PPL, although ductal adenocarcinoma is more likely if the vessel walls drastically change with early infiltration, erosion, stenosis, and tumoral thrombosis.…”