title: Multifocal lesions with pancreatic atrophy in IgG4-related autoimmune pancreatitis: report of a case.
abstract: We herein report a case of IgG4-related autoimmune pancreatitis (AIP). A 72-year-old male with jaundice visited our hospital complaining of epigastralgia. A blood chemistry analysis revealed elevated serum levels of total bilirubin and DUPAN-II. Computed tomography (CT) revealed irregularly shaped pancreatic masses with a stricture of the main pancreatic duct (MPD) in the head and tail that were interposed by marked atrophy with MPD dilation in the body. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed abnormally intense FDG uptake only at the masses. During surgery, another small tumor was also found in the atrophied body; therefore, a total pancreatectomy was performed under the diagnosis of multiple pancreatic cancers. The histological analysis revealed fibrosis with dense and diffuse infiltrations of lymphocytes and IgG4-positive plasma cells. The pancreatic parenchyma of the body was firmly replaced by fibrosis. AIP can lead to the formation of multiple pancreatic lesions, and thus the correct diagnosis is occasionally difficult to establish in atypical cases.
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan, akifumi@muse.ocn.ne.jp.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Kimura
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hatsuse
authors.forename: Suefumi
authors.initials: S
authors.lastname: Aosasa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nishiyama
authors.forename: Tadashi
authors.initials: T
authors.lastname: Maejima
authors.forename: Sho
authors.initials: S
authors.lastname: Ogata
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimazaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawaguchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
mesh_terms: D000368:Aged; D001284:Atrophy; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology* / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology*; D008297:Male; D010179:Pancreas / Q000473:pathology*; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G
references.citation: Magn Reson Med Sci. 2002;1(1):54-8
references.pmid: 16037669
references.citation: Am J Gastroenterol. 1998 Jan;93(1):99-102
references.pmid: 9448184
references.citation: Cytopathology. 2006 Feb;17(1):27-33
references.pmid: 16417562
references.citation: J Hepatobiliary Pancreat Surg. 2008;15(4):449-52
references.pmid: 18670850
references.citation: JOP. 2007 Sep 07;8(5):598-604
references.pmid: 17873466
references.citation: Am J Surg Pathol. 2005 Nov;29(11):1464-71
references.pmid: 16224213
references.citation: AJR Am J Roentgenol. 1998 May;170(5):1323-7
references.pmid: 9574610
references.citation: J Am Coll Surg. 2010 Dec;211(6):749-53
references.pmid: 21109158
references.citation: Intern Med. 2010;49(15):1527-32
references.pmid: 20686284
references.citation: Clin Radiol. 2010 Sep;65(9):735-43
references.pmid: 20696301
references.citation: Digestion. 2009;79(4):220-8
references.pmid: 19390194
references.citation: World J Gastroenterol. 2008 Jul 7;14(25):3948-55
references.pmid: 18609677
references.citation: Dig Dis Sci. 1995 Jul;40(7):1561-8
references.pmid: 7628283
references.citation: Radiat Med. 2006 Oct;24(8):587-91
references.pmid: 17041797
references.citation: Pancreatology. 2009;9(5):694-9
references.pmid: 19684434
references.citation: Semin Nucl Med. 2002 Jan;32(1):47-59
references.pmid: 11839069
references.citation: Gastrointest Endosc. 2005 Mar;61(3):467-72
references.pmid: 15758927
references.citation: J Gastroenterol. 2006 Dec;41(12):1197-205
references.pmid: 17287899
references.citation: JOP. 2010 Jul 05;11(4):389-92
references.pmid: 20601817
references.citation: Case Rep Gastroenterol. 2011 Sep;5(3):528-33
references.pmid: 22087084
references.citation: Surgery. 2000 Dec;128(6):903-9
references.pmid: 11114622