Focal Autoimmune Pancreatitis Morphologically Mimicking Pancreatic Cancer: A Case Report and Literature Review.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Daniel Paramythiotis, Eleni Karlafti, Krystallenia Siniosoglou, Dimitrios Tsavdaris, Ioanna Abba Deka, Georgia Raptou, Xanthippi G Mavropoulou, Elizabeth Psoma, Stavros Panidis, Antonios Michalopoulos
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Abstract

BACKGROUND Autoimmune pancreatitis (AIP) is identified as an outlier in the clinical practice of chronic pancreatitis caused by autoimmune system dysfunction. AIP is classified into 3 subtypes: AIP type 1 and AIP type 2, which are both sensitive to corticosteroids, and the recently introduced AIP type 3. CASE REPORT We present a case of a patient who presented with painless obstructive jaundice. Computed tomography (CT) revealed hyperdense gallbladder material, further dilatation of intrahepatic bile ducts, and distention of the bile duct (15 mm). Based on the available clinical data, which were strongly compatible with pancreatic cancer, Whipple surgery was selected as the treatment for this case. The consequent histopathological report revealed areas of pancreatic parenchyma with fibrous connective tissue development and dense inflammatory cell infiltration with lymphocytes and plasmacytes, which showcased IgG4 positivity. The clinical results suggested a diagnosis of AIP type 1, and the patient was referred to his treating physician for further treatment of AIP. Preoperative histological examination of the pancreas, along with evaluation of the radiological and serological features, could have aided in determining the diagnosis of AIP type 1 pancreatitis despite the unique abnormality of this particular case. CONCLUSIONS Given the aforementioned conditions, AIP, even as a rare clinical entity, emerges as a canonical ailment and should be considered a viable possibility in clinical practice since it can exclude the patient from an unnecessary surgery.

病灶性自身免疫性胰腺炎形态学上模仿胰腺癌:病例报告与文献综述
背景 自体免疫性胰腺炎(AIP)被认为是由自身免疫系统功能障碍引起的慢性胰腺炎临床实践中的异类。AIP 可分为 3 个亚型:AIP 1 型和 AIP 2 型(均对皮质类固醇敏感)以及最近出现的 AIP 3 型。病例报告 我们报告了一例出现无痛性梗阻性黄疸的患者。计算机断层扫描(CT)显示胆囊物质密度过高,肝内胆管进一步扩张,胆管胀大(15 毫米)。根据现有的临床数据,该病例与胰腺癌十分吻合,因此选择了 Whipple 手术作为治疗方法。随后的组织病理报告显示,胰腺实质区域纤维结缔组织发育,淋巴细胞和浆细胞等致密炎性细胞浸润,显示 IgG4 阳性。临床结果提示诊断为 AIP 1 型,患者被转诊至主治医生处接受进一步的 AIP 治疗。术前胰腺组织学检查以及放射学和血清学特征评估本可帮助确定 AIP 1 型胰腺炎的诊断,尽管该病例的异常情况比较特殊。结论 鉴于上述情况,AIP 即使是一种罕见的临床实体,也是一种典型的疾病,在临床实践中应被视为一种可行的可能性,因为它可以使患者免于不必要的手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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