[Autoimmune pancreatitis--a rare and difficult differential diagnosis to pancreatic cancer].
BACKGROUND
Autoimmune pancreatitis (AIP) is a rare disorder. Typical clinical symptoms include extrahepatic cholestasis, abdominal pain, and weight loss.


METHODS
The case of a patient with cholestatic icterus and double duct sign is reported, who underwent surgery (Whipple operation) because of suspected pancreatic cancer. Histology of the resected pancreas head revealed AIP. Due to this diagnosis, measurement of IgG4 showed a significantly elevated serum level. Postoperatively, cholestasis parameters remained elevated, which was interpreted as associated sclerosing cholangitis. Therapy with corticosteroids led to normalization of the cholestasis within 4 weeks.


CONCLUSIONS
AIP should be taken into account as differential diagnosis to pancreatic cancer, especially in cases without clear demarcation of a pancreatic tumor. Measurement of IgG4 may be an important parameter to avoid unnecessary surgery.
Breuer
Arnulf
A
Klinikverbund Südwest-Krankenhaus Nagold, Interdisziplinäres Bauchzentrum, Nagold, Germany.
Benz
Stefan R
SR
Enz
Thomas
T
Deubler
Gabriele
G
Mörk
Hubert
H
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone