Difficulty in diagnosing pseudotumoral autoimmune pancreatitis: two original cases

##plugins.themes.academic_pro.article.sidebar##

Published Dec 2, 2010
Download
pdf
Vol. 88 No. 12 (2010): Issue Dec 2010

##plugins.themes.academic_pro.article.main##

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

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.

Keywords:

Autoimmune pancreatitis, Ig G4, Pancreatic biopsy, steroids

##plugins.themes.academic_pro.article.details##

References

  1. Finkelberg D.L., Sahani D., Deshpande V., Brugge W.R. Autoimmune pancreatitis. N Engl J Med 2006; 355: 2670-76
  2. Dite P, Novotny I, Trna J, Sevcikova A. Autoimmune pancreatitis. Best Prac Research Clin Gastroenterology 2008; 22:131-43
  3. Okazaki K, Chiba T. Autoimmune related pancreatitis. Gut 2002; 51:1-4.
  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.
  5. Okazaki K, Uchida K, Chiba T. Recent concept of autoimmunerelated pancreatitis. J Gastroenterol 2001; 36: 293-302
  6. 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
  7. Irie H, Honda H, Baba S, et al. Autoimmune pancreatitis: CT and MR characteristics.AJR Am J Roentgenol 1998 ; 170 :1323-7
  8. Nishimura T, Masaoka T, Suzuki H, Aiura K, Nagata H, Ishii H. Autoimmune pancreatitis with pseudocysts. J Gastroenterol 2004; 39: 1005-10.
  9. 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
  10. Ectors N, Maillet B, Aerts R, et al. Non-alcoholic duct destructive chronic pancreatitis. Gut 1997; 41: 263-8
  11. 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.
  12. 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.
  13. 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
  14. 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
  15. 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.
  16. Kamisawa T, Egawa N, Nakajima H, et al. Extrapancreatic lesions in auto-immune pancreatitis. J Clin Gastroenterol 2005; 39: 904-7.
  17. Ohara H, Nakazawa T, Sano H, et al. Systemic extrapancreatic lesions associated with auoimmune pancreatitis. Pancreas 2005; 31: 232-7.
  18. 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.
  19. 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.
  20. Uchida K, Okazaki K, Konishi Y, et al. Clinical analysis of autoimmune-related pancreatitis. Am J Gastroenterol 2000; 95: 2788-94.
  21. 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.
  22. 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.
  23. 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.
  24. 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).
  25. 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.