Abstract
Autoimmune pancreatitis is a rare type of chronic pancreatitis. It is supposed to be a pancreatic manifestation of an immune-complex modulated systemic disorder. In contrast, pancreatic adenocarcinoma is the most frequent malignant neoplasm of the pancreas. Within the rare type of focal autoimmune pancreatitis, only few presentations with multifocal pancreatic lesions have been described. Herein we report a case of a 58-year-old patient with autoimmune pancreatitis presenting with bifocal manifestations of the pancreatic head and tail, mimicking pancreatic adenocarcinoma clinically, on computed tomography and magnetic resonance imaging. Typical imaging findings of autoimmune pancreatitis are compared with typical findings in pancreatic carcinoma. The diagnostic dilemma of differentiating between both entities is discussed. A review of the present literature regarding multifocal presence of autoimmune pancreatitis is performed.
Highlights
Autoimmune pancreatitis (AIP) is a rare type of chronic pancreatitis.[1]
Common to all AIP is a pancreatic manifestation of an immune-complex modulated systemic disorder that is characterized by prominent lymphocyte infiltration and associated organ fibrosis.[1]
Calculated steroid therapy could have been diagnostic for AIP, yet it should only be performed in patients with highly suggestive AIP after thorough workup for pancreatic adenocarcinoma
Summary
Autoimmune pancreatitis (AIP) is a rare type of chronic pancreatitis (occurring between 5% and 6%).[1]. A 58-year-old female patient with a suspicious mass of the pancreas found in an ultrasound examination was referred to our hospital for further evaluation and treatment. She presented with pain radiating around her back, 3 days of nausea and vomiting, jaundice, and new-onset type 2 diabetes. Intrahepatic cholestasis by stenosis of the bile duct was present (Figure 1C); the pancreatic main duct was not enlarged on CT. In correlation to CT, MRI consistently revealed 2 focally well-circumscribed masses of the pancreatic head and tail. Given the local respectability assessed on CT and MRI, a total pancreatectomy was chosen primarily in a curative intent to remove the mass together with the inflammatory tail in the diabetic patient. A final diagnosis of autoimmune pancreatitis (AIP, type 1) was made
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