title: The challenging diagnosis of pancreatic masses: not all tumors are cancers.
abstract: In the elderly patients, where biopsy-induced complications could outweigh the benefit, the identification of pancreatic masses is generally referred to as a synonymous of pancreatic cancer and patients are dismissed with no further options than palliative and supportive care. Notwithstanding, not all pancreatic tumors are cancers and therefore alternative diagnoses need to be investigated, especially when patients are unfit for invasive diagnostic procedures. Here, we report a case of an aged patient that was admitted to an internal medicine division for a previously diagnosed pancreatic cancer. The reassessment of the diagnosis has allowed identifying the pancreatic mass as a manifestation of focal pancreatitis in the context of an IgG4-related disease. Accordingly, patient was treated with steroids with rapid clinical improvement. This clinical case suggests that autoimmune diseases should always be considered in the differential diagnosis of pancreatic masses of the elderly.
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano 10043, Italy ; Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morotti
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Turin, Orbassano 10043, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gned
authors.affiliation: Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Di Martino
authors.affiliation: Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Cristaldi
authors.affiliation: Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Alì
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano 10043, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nicoli
authors.affiliation: Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Turin, Orbassano 10043, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano 10043, Italy ; Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy.
authors.forename: Angelo
authors.identifier: 0000-0002-1911-795X
authors.initials: A
authors.lastname: Guerrasio