Abstract
BackgroundDifferentiation between pancreatic cancer (PC) and focal form of autoimmune pancreatitis (AIP) is very challenging, with similar clinical presentations, laboratory results and morphologic imagings of US, CT, EUS, MRI, ERCP, PET-CT. Even serum IgG4 and biopsy sometimes cannot give clear-cut differential accurate diagnostis. Considering the totally different management strategy of the two diseases, accurate diagnostic value is urgently needed to remind the clinicians of the rare diagnosis of untypical AIP among frequent PC-suspected patients.ResultsWe present 2 laparotomy cases of AIP that had a high similar characteristic to PC and retrospectively extracted the warning signs that may help select untypical AIP in PC-suspected patients.ConclusionsWe find that mild fluctuating jaundice with abdominal pain, young age, tumor marker of TPS, TPA and diverse results between variable radiological tests can help to differentiate AIP mass from PC, through retrospectively analyzing work-up process of AIP in two patients who underwent laparotomy for suspected PC.
Highlights
Differentiation between pancreatic cancer (PC) and focal form of autoimmune pancreatitis (AIP) is very challenging, with similar clinical presentations, laboratory results and morphologic imagings of US, CT, EUS, MRI, ERCP, PET-CT
Further examination showed all the serum immune antibody including immunoglobulin G4 (IgG4) were within normal range except slightly elevation of IgM and AMA (Table 2)
Based on the postoperative recurrence of jaundice, elevated serum IgG4 level, MRI findings and good response to corticosteroid treatment, the diagnosis of AIP was confirmed, the specimen of bile cyst and regional lymph nodes showed no fibrous tissue with focal sclerotic stroma, focal lymphoid cell aggregation or IgG4-positive plasma cells
Summary
Differentiation between pancreatic cancer (PC) and focal form of autoimmune pancreatitis (AIP) is very challenging, with similar clinical presentations, laboratory results and morphologic imagings of US, CT, EUS, MRI, ERCP, PET-CT. Even serum IgG4 and biopsy sometimes cannot give clear-cut differential accurate diagnostis. Considering the totally different management strategy of the two diseases, accurate diagnostic value is urgently needed to remind the clinicians of the rare diagnosis of untypical AIP among frequent PC-suspected patients. Autoimmune pancreatitis (AIP) is a unique pancreatic manifestation of systemic immunoglobulin G4 (IgG4)-related sclerosing disease, histopathologically characterized by abundant infiltration of IgG4-positive lymphoplasmacyte and fibrosis of the pancreas with obliterative phlebitis [1]. Contrary to typical AIPs, patients with untypical local lesion AIP and pancreatic cancer (PC) share similar clinical presentations, laboratory measurements, morphologic features of radiological examinations. Measurement of serum IgG4 has become a useful tool for their differentiation. PC and retrospectively extracted the warning signs for discrimination of untypical AIP in PC-suspected patients
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