title: [A case of autoimmune pancreatitis with multifocal mass lesions].
abstract: We present a case of a 73-year-old man with multifocal autoimmune pancreatitis (AIP) in the pancreatic head and tail, and who had undergone sigmoidectomy and rectectomy 28 months before presenting to our department. Upon presentation, his serum IgG4 level was elevated at 267mg/dl, but tumor marker levels were within normal ranges. CT and MRI showed two localized pancreatic masses with delayed enhancement, but endoscopic retrograde pancreatography revealed neither stenosis nor dilatation of the main pancreatic duct. FDG-PET examination showed intense uptake in regions concordant with both tumors. The possibility of atypical AIP was a concern, but malignant tumor could not be clinically or radiologically excluded. Endoscopic ultrasonographic fine-needle aspiration biopsy was performed, but no malignant cells were detected. The patient underwent subsequent distal pancreatectomy. Histological evaluation of the tumors showed the presence of many IgG4-positive plasma cells without any evidence of malignancy.
authors.affiliation: Department of Gastroenterology, Osaka City General Hospital, Japan. hiramatsu@hospital.city.osaka.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hiramatsu
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nebiki
authors.forename: Ayako
authors.initials: A
authors.lastname: Ueno
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Maruyama
authors.forename: Takehisa
authors.initials: T
authors.lastname: Suekane
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Eiji
authors.initials: E
authors.lastname: Sasaki
authors.forename: Koji
authors.initials: K
authors.lastname: Sano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
mesh_terms: D000368:Aged; D001327:Autoimmune Diseases / Q000473:pathology*; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery; D012811:Sigmoid Neoplasms / Q000601:surgery