Difficulty in diagnosing pseudotumoral autoimmune pancreatitis: two original cases

Authors

  • Norsaf Bibani
  • Sami Karoui
  • Faouzi Chebbi Department of Surgery
  • Meriem Serghini
  • Kais Nouira
  • Jalel Boubaker
  • Emna Mnif
  • Zouhair Ben Safta
  • Azza Filali

Keywords:

Autoimmune pancreatitis, Ig G4, Pancreatic biopsy, steroids

Abstract

Background : In recent years, autoimmune pancreatitis (AIP) has been increasingly recognized. The diagnosis of AIP is based on a series of clinical, biological and radiological criteria. In imaging, it may appear as two different forms: a diffuse form by destroying channels and pseudotumoral lesions that can cause inadequate resections.
Aim: To report two new cases of pseudotumoral autoimmune pancreatitis
Cases report: We report two cases of pseudotumoral autoimmune pancreatitis, with different clinical, biological and radiologic features.
The diagnosis was established easily in one case and after surgery in a 2nd case.
Conclusion: Our two cases underline the difficulties still encountered in the diagnosis of AIP.

Downloads

Download data is not yet available.

References

Finkelberg D.L., Sahani D., Deshpande V., Brugge W.R. Autoimmune pancreatitis. N Engl J Med 2006; 355: 2670-76

Dite P, Novotny I, Trna J, Sevcikova A. Autoimmune pancreatitis. Best Prac Research Clin Gastroenterology 2008; 22:131-43

Okazaki K, Chiba T. Autoimmune related pancreatitis. Gut 2002; 51:1-4.

Nahon Uzan K, Levy P, O'Toole D, et al. Is idiopathic chronic pancreatitis an autoimmune disease ? Clin Gastroenterol Hepatol 2005; 3: 903-9.

Okazaki K, Uchida K, Chiba T. Recent concept of autoimmunerelated pancreatitis. J Gastroenterol 2001; 36: 293-302

Horiuchi A, Kawa S, Akamatsu T, et al. characteristic pancreatic duct appearance in autoimmune chronic pancreatitis: a case report and review of the Japanese literature. Am J Gastroenterol 1998; 93: 260-3

Irie H, Honda H, Baba S, et al. Autoimmune pancreatitis: CT and MR characteristics.AJR Am J Roentgenol 1998 ; 170 :1323-7

Nishimura T, Masaoka T, Suzuki H, Aiura K, Nagata H, Ishii H. Autoimmune pancreatitis with pseudocysts. J Gastroenterol 2004; 39: 1005-10.

Horiuchi A, Kawa S, Hamano H, Hayama M, Ota H, Kiyosawa K. ERCP features in 27 patients with auto-immune pancreatitis. Gastrointest endosc 2002; 55: 494-9

Ectors N, Maillet B, Aerts R, et al. Non-alcoholic duct destructive chronic pancreatitis. Gut 1997; 41: 263-8

Hamano H, Kawa S, Horiuchi A, Unno H, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med 2001; 344: 732-8.

Aparisi L, Farre A, Gomez-Cambronero L et al. Antibodies to carbonic anhydrase and Ig G4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis. Gut 2005; 54: 703-709.

Okasaki K, Uchida K, Ohana M, et al. Auto-immune-related pancreatitis is associated with autoantibodies and a Th1/Th2-type cellular immune response. Gastroenterology 2000; 118: 573-81

Epstein O, Chapman RW, Lake- Bakaar G, Foo AY, Rosalki SB, Sherlock S. The pancreas in primary biliary cirrhosis and primary sclerosing cholangitis. Gastroenterology 1982; 83:1177-82

Barthet M, Hastier P, Bernard JP, et al. Chronic pancreatitis and inflammatory bowel disease: true or coincidental association? Am J Gastroenterol 1999; 94: 199-201.

Kamisawa T, Egawa N, Nakajima H, et al. Extrapancreatic lesions in auto-immune pancreatitis. J Clin Gastroenterol 2005; 39: 904-7.

Ohara H, Nakazawa T, Sano H, et al. Systemic extrapancreatic lesions associated with auoimmune pancreatitis. Pancreas 2005; 31: 232-7.

Levy MJ, Reddy RP,Wiersema MJ, et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest endosc 2005; 61: 467-72.

Zamboni G, Luttges J, Capelli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchow Arch 2004; 445: 552-63.

Uchida K, Okazaki K, Konishi Y, et al. Clinical analysis of autoimmune-related pancreatitis. Am J Gastroenterol 2000; 95: 2788-94.

Kamisawa T, Egawa M, Nakajima H, Tsuruta K, Okamoto A. Morphological changes after steroid therapy in autoimmune pancreatitis. Scand J Gastroenterol 2004; 39:1154-8.

Saito T, Tanaka S, Yoshida H, et al. A case of autoimmune pancreatitis responding to steroid therapy. Evidence of histologic recovery. Pancreatol 2002; 2: 550-6.

Pyun DK, Choi WB, Kim MH, et al. Autoimmune chronic pancreatitis relapsing despite the maintenance dose of steroid. Korean J Intern Med 2005; 20: 163-7.

Kamisawa T, Yoshiike M, Egawa M, Nakajima H, Tsuruta K, Okamoto A. Treating patients with autoimmune pancreatitis:results from a long-term follow-up study. Pancreatol 2005; 5: 234-8 (discussion 238-40).

Ozden I, Dizdaroglu F, Poyanli A, Zmre A. Spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis. Pancreatol 2005; 5: 300-3.

Downloads

Published

2010-12-02

Issue

Section

Case report