Autoimmune pancreatitis presenting as a pancreatic head tumor: Report of a case
Journal Volume
21
Journal Issue
5
Pages
366-372
ISSN
1016-7390
Date Issued
2010-10
Author(s)
Abstract
Autoimmune pancreatitis (AIP) is a benign form of chronic pancreatitis that is associated with autoimmune processes demonstrated on clinical images, laboratory, and histopathologic features. We herein report the case of a 67-year-old man with a history of diabetes mellitus for one year who was referred to our emergency department because of painless jaundice for 3 days. Abdominal computed tomography revealed diffuse but uniformly enhanced pancreatic enlargement, especially in the pancreatic head. On endoscopic retrograde cholangio-pancreatography, the main pancreatic duct had an irregular contour and diffuse attenuation. There was also a stricture of the distal common bile duct. Endoscopic ultrasound imaging showed a reticular pattern and diffuse enlargement of pancreatic parenchyma. There was a 3.0 x 2.7 cm relative hypoechoic lesion in the pancreatic head. Tissue diagnosis was made by laparoscopic biopsy, which revealed abundant lymphoplasmacytic cell infiltrates accompanied by periductal inflammation by histopathology. The serum immunoglobulin G4 level was greater than 160 mg/ dL. These findings led to a diagnosis of autoimmune pancreatitis for which the treatment of choice is corticosteroids. Our patient was still alive and being treated with oral steroids one year later. The imaging and jaundice improved after treatment, however the pre-existing diabetes mellitus did not improve during the steroid therapy.
Publisher
Journal of Internal Medicine of Taiwan
Type
journal article