Skip to main content

Advertisement

SpringerLink
Log in

A case of pancreatic carcinoma with suspected autoimmune pancreatitis

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

We present a case of pancreatic carcinoma with strongly suspected coexisting autoimmune pancreatitis (AIP). The patient presented with a chief complaint of icterus and weight loss, and was referred to our institution after a pancreatic lesion was found. Blood test showed elevation of serum bilirubin, hepato-biliary enzyme, glucose and tumor markers, and also high levels of serum IgG4 (344 mg/dl, normal 4.8–105 mg/dl) and anti-DNA antibody (14 IU/ml, normal <6.0 IU/ml). Ultrasonography demonstrated an enlarged pancreas with smooth borders and low internal echo density. Enhanced computed tomography (CT) showed a sausage-shaped pancreas without definitive metastasis to the surrounding lymph nodes and liver. Imaging of the pancreatic duct, including endoscopic retrograde pancreatography (ERP) and magnetic resonance cholangiopancreatography (MRCP), showed stenosis of the main pancreatic duct at the pancreatic head as well as a long segment of narrowing at the body and no dilatation at the tail. Tissues from these stenotic sites and open biopsy from pancreatic body showed infiltrating adenocarcinoma and dense fibrosis. To date, only a small number of reports have described pancreatic carcinoma accompanied with AIP. It is important to confirm diagnosis with histology in cases of suspicious autoimmune pancreatitis, even when the clinical images are compatible with AIP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Okazaki K, Uchida K, Fukui T. Recent advances in autoimmune pancreatitis: concept, diagnosis, and pathogenesis. J Gastroenterol. 2008;43(6):409–18.

    Article  CAS  PubMed  Google Scholar 

  2. Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N. Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol. 2003;98(12):2694–9.

    Article  PubMed  Google Scholar 

  3. Nakazawa T, Ohara H, Sano H, Ando T, Imai H, Takada H, et al. Difficulty in diagnosing autoimmune pancreatitis by imaging findings. Gastrointest Endosc. 2007;65(1):99–108.

    Article  PubMed  Google Scholar 

  4. Matsubayashi H, Furukawa H, Uesaka K, Sasaki K, Ono H, Hruban RH. Autoimmune pancreatitis accompanied with cholecystistis, periaortitis and pseudotumors of the liver. Case Rep Gastroenterol. 2008;1(2):155–61.

    Article  Google Scholar 

  5. Kajiwara M, Gotohda N, Konishi M, Nakagohri T, Takahashi S, Kojima M, et al. Incidence of the focal type of autoimmune pancreatitis in chronic pancreatitis suspected to be pancreatic carcinoma: experience of a single tertiary cancer center. Scand J Gastroenterol. 2008;43(1):110–6.

    Article  PubMed  Google Scholar 

  6. Kamisawa T, Tu Y, Egawa N, Tsuruta K, Okamoto A, Kodama M, et al. Can MRCP replace ERCP for the diagnosis of autoimmune pancreatitis? Abdom Imaging 2008 (in press).

  7. Kamisawa T, Chen PY, Tu Y, Nakajima H, Egawa N, Tsuruta K, et al. Pancreatic cancer with a high serum IgG4 concentration. World J Gastroenterol. 2006;12(38):6225–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ohtsubo K, Watanabe H, Okada G, Tsuchiyama T, Mouri H, Yamaguchi Y, et al. A case of pancreatic cancer with formation of a mass mimicking alcoholic or autoimmune pancreatitis in a young man. Possibility of diagnosis by hypermethylation of pure pancreatic juice. JOP. 2008;9(1):37–45.

    PubMed  Google Scholar 

  9. Fukui T, Mitsuyama T, Takaoka M, Uchida K, Matsushita M, Okazaki K. Pancreatic cancer associated with autoimmune pancreatitis in remission. Intern Med. 2008;47(3):151–5.

    Article  PubMed  Google Scholar 

  10. Inoue H, Miyatani H, Sawada Y, Yoshida Y. A case of pancreas cancer with autoimmune pancreatitis. Pancreas. 2006;33(2):208–9.

    Article  PubMed  Google Scholar 

  11. Witkiewicz AK, Kennedy EP, Kennyon L, Yeo CJ, Hruban RH. Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma: case report and review of the literature. Hum Pathol. 2008;39(10):1548–51.

    Article  PubMed  Google Scholar 

  12. Ozaki Y, Oguchi K, Hamano H, Arakura N, Muraki T, Kiyosawa K, et al. Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography. J Gastroenterol. 2008;43(2):144–51.

    Article  CAS  PubMed  Google Scholar 

  13. Infante JR, Matsubayashi H, Sato N, Tonascia J, Klein AP, Riall TA, et al. Peritumoral fibroblast SPARC expression and patient outcome with resectable pancreatic adenocarcinoma. J Clin Oncol. 2007;25(3):319–25.

    Article  PubMed  Google Scholar 

  14. Adsay NV, Basturk O, Thirabanjasak D. Diagnostic features and differential diagnosis of autoimmune pancreatitis. Semin Diagn Pathol. 2005;22(4):309–17.

    Article  PubMed  Google Scholar 

  15. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344(10):732–8.

    Article  CAS  PubMed  Google Scholar 

  16. Raina A, Krasinskas AM, Greer JB, Lamb J, Fink E, Moser AJ, et al. Serum immunoglobulin G fraction 4 levels in pancreatic cancer: elevations not associated with autoimmune pancreatitis. Arch Pathol Lab Med. 2008;132(1):48–53.

    CAS  PubMed  Google Scholar 

  17. Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol. 2007;102(8):1646–53.

    Article  CAS  PubMed  Google Scholar 

  18. Takahashi K, Yamao K, Okubo K, Sawaki A, Mizuno N, Ashida R, et al. Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA. Gastrointest Endosc. 2005;61(1):76–9.

    Article  PubMed  Google Scholar 

  19. Wakatsuki T, Irisawa A, Bhutani MS, Hikichi T, Shibukawa G, Takagi T, et al. Comparative study of diagnostic value of cytologic sampling by endoscopic ultrasonography-guided fine-needle aspiration and that by endoscopic retrograde pancreatography for the management of pancreatic mass without biliary stricture. J Gastroenterol Hepatol. 2005;20(11):1707–11.

    Article  PubMed  Google Scholar 

  20. Uchida N, Kamada H, Tsutsui K, Ono M, Aritomo Y, Masaki T, et al. Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma. J Gastroenterol. 2007;42(8):657–62.

    Article  PubMed  Google Scholar 

  21. Levy MJ. Endoscopic ultrasound-guided trucut biopsy of the pancreas: prospects and problems. Pancreatology. 2007;7(2–3):163–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Ralph H. Hruban of Johns Hopkins Medical Institutions in the USA for his assistance with reviewing the English of the manuscript and providing beneficial comments.

Author information

Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

    Hiroyuki Matsubayashi & Hiroyuki Ono

  2. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

    Kazuya Matsunaga & Katsuhiko Uesaka

  3. Division of GI Oncology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

    Akira Fukutomi

  4. Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

    Keiko Sasaki

  5. Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

    Hiroyoshi Furukawa

Authors
  1. Hiroyuki Matsubayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuya Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuhiko Uesaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akira Fukutomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keiko Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroyoshi Furukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroyuki Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyuki Matsubayashi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matsubayashi, H., Matsunaga, K., Uesaka, K. et al. A case of pancreatic carcinoma with suspected autoimmune pancreatitis. Clin J Gastroenterol 2, 59–63 (2009). https://doi.org/10.1007/s12328-008-0045-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-008-0045-9

Keywords

Search

Navigation