EUS-FNA contribution in the identification of autoimmune pancreatitis: a case report.
BACKGROUND
Autoimmune pancreatitis is a benign inflammatory disease of the pancreas which mimics pancreatic malignancy both clinically and radiologically. Autoimmune pancreatitis is presented as a diffuse enlargement of the pancreas and as a diffuse irregular narrowing of the main pancreatic duct.


METHODS
We report the endoscopic-ultrasound-guided (EUS-guided) fine needle aspiration (FNA) cytology features of a case with autoimmune pancreatitis. A 24-year-old woman with diabetes mellitus was admitted to our hospital after having painless jaundice for 15 days. She denied any alcohol consumption. The biochemical profile showed a marked elevation of bilirubin and hyperglycemia while gamma-GT and CA 19-9 levels were increased fivefold. The immunologic profile of the patient was negative. EUS revealed diffuse hypoechoic pancreatic enlargement (sausage-like appearance of the pancreas). EUS-FNA was performed and the smears were rich in inflammatory cells (mainly lymphoplasmacytes) with sparse epithelial cells lacking atypia, elements which show a strong correlation between the histopathological and cytological findings. The patient underwent steroid therapy which led to resolution of the clinical symptoms and imaging abnormalities within a month.


CONCLUSIONS
The FNA-cytology findings in conjunction with clinical and EUS findings could potentially establish a diagnosis of autoimmune pancreatitis and exclude carcinoma, thus preventing pancreatic resection.
Salla
Charitini
C
Department of Cytology, Athens General Hospital, Athens, Greece.
Chatzipantelis
Paschalis
P
Konstantinou
Panagiotis
P
Karoumpalis
Ioannis
I
Pantazopoulou
Akrivi
A
Tsiotos
Grigorios
G
D000328:Adult; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D010179:Pancreas / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology*