title: Autoimmune pancreatitis: medical and surgical management.
abstract: BACKGROUND
  Autoimmune pancreatitis is characterised by a lymphoplasmacytic infiltrate consisting in part of plasma cells that produce large amounts of IgG4. It can manifest as focal or diffuse enlargement of the pancreas with associated strictures of the pancreato-bilary tree giving rise to symptoms including abdominal pain, weight loss and obstructive jaundice; thus it can be extremely difficult in both presentation and investigation to distinguish from pancreatic carcinoma. Recent advances now facilitate preoperative diagnosis and effective medical management, including steroid treatment of autoimmune pancreatitis so preventing major surgical intervention.
  
  
  METHODS
  Two cases of autoimmune pancreatitis are described, each of which presented with obstructive jaundice and a relatively painless pancreatic mass, one with vascular involvement. They each had elevated serum CA 19-9 and ultimately required surgical exploration to definitely exclude malignancy before embarking on non operative treatment. The first case settled spontaneously while the second rapidly improved with steroid treatment.
  
  
  CONCLUSIONS
  These two cases illustrate the difficulties in diagnosing this condition, the efficacy of steroid therapy and the role of surgical intervention in unresponsive cases or those where a diagnostic dilemma remains.
authors.affiliation: Professorial Surgical Unit, The University of Dublin, Trinity College, Adelaide, Dublin, Republic of Ireland.
authors.forename: Desmond P
authors.initials: DP
authors.lastname: Toomey
authors.forename: Niall
authors.initials: N
authors.lastname: Swan
authors.forename: William
authors.initials: W
authors.lastname: Torreggiani
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Conlon
mesh_terms: D001327:Autoimmune Diseases / Q000175:diagnosis / Q000628:therapy*; D018395:CA-19-9 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000145:classification; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen; D007074:Immunoglobulin G