Neutrophil Infiltration and Acinar-ductal Metaplasia Are the Main Pathological Findings in Pembrolizumab-induced Pancreatitis

Intern Med. 2022 Dec 15;61(24):3675-3682. doi: 10.2169/internalmedicine.9565-22. Epub 2022 May 7.

Abstract

The histopathological findings of immune checkpoint inhibitor (ICI)-induced pancreatitis have rarely been reported. A 56-year-old man with squamous cell carcinoma of the lung with bone metastasis was being treated with pembrolizumab, an anti-programmed cell death protein-1 antibody. After 13 doses, he was referred to our department due to pancreatitis. Despite characteristic symptoms of acute pancreatitis, imaging findings were similar to those of autoimmune pancreatitis. However, a histological examination showed neutrophil-based inflammatory cell infiltration and acinar-ductal metaplasia. Immunostaining showed CD8-positive T lymphocyte infiltration. This case revealed the characteristic histopathology of pembrolizumab-induced pancreatitis, which was previously poorly understood.

Keywords: adverse drug event; endoscopic ultrasonography; immune checkpoint inhibitor; immunohistochemistry; pancreatitis; pembrolizumab.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Humans
  • Male
  • Metaplasia / chemically induced
  • Middle Aged
  • Neutrophil Infiltration
  • Pancreatitis* / chemically induced
  • Pancreatitis* / pathology

Substances

  • pembrolizumab