[An IgG4-related pancreatitis mimicking an adenocarcinoma: A case report]

Ann Pathol. 2015 Dec;35(6):511-4. doi: 10.1016/j.annpat.2015.05.017. Epub 2015 Nov 17.
[Article in French]

Abstract

Type 1 auto-immune pancreatitis (type 1 AIP) is the pancreatic manifestation of IgG4-related systemic disease (IgG4-RD). This disease has recently been individualized and is characterized by elevated serum IgG4 levels and extrapancreatic lesions with common histologic characteristic: dense infiltration of lymphocytes, IgG4-positive plasma cells and storiforme fibrosis. Obliterative phlebitis is frequently detected. The pancreas is frequently involved in this disease. As approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological and histopathological features. In pseudotumoral cases, AIP can be misdiagnosed as pancreatic cancer. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection. We report here a case of a patient who underwent surgery for presumed pancreatic cancer. The final diagnosis was type 1 AIP.

Keywords: Adénocarcinome pancréatique; Forme pseudotumorale; IgG4-related disease; Maladie sclérosante à IgG4; Pancreatic adenocarcinoma; Pancréatite auto-immune type 1 (PAI type 1); Pseudotumoral case; Type 1 auto-immune pancreatitis (type 1 AIP).

Publication types

  • Case Reports
  • English Abstract
  • Review

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Aged
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / etiology
  • Autoimmune Diseases / pathology
  • Autoimmune Diseases / surgery
  • Biopsy
  • Diagnostic Errors*
  • Humans
  • Hypergammaglobulinemia / complications*
  • Immunoglobulin G / analysis*
  • Jaundice, Obstructive / etiology
  • Laparotomy
  • Male
  • Pancreatic Neoplasms / diagnosis*
  • Pancreaticoduodenectomy
  • Pancreatitis / diagnosis*
  • Pancreatitis / etiology
  • Pancreatitis / pathology
  • Pancreatitis / surgery
  • Weight Loss

Substances

  • Immunoglobulin G