title: A case of pancreatic carcinoma with suspected autoimmune pancreatitis.
abstract: We present a case of pancreatic carcinoma with strongly suspected coexisting autoimmune pancreatitis (AIP). The patient presented with a chief complaint of icterus and weight loss, and was referred to our institution after a pancreatic lesion was found. Blood test showed elevation of serum bilirubin, hepato-biliary enzyme, glucose and tumor markers, and also high levels of serum IgG4 (344 mg/dl, normal 4.8-105 mg/dl) and anti-DNA antibody (14 IU/ml, normal <6.0 IU/ml). Ultrasonography demonstrated an enlarged pancreas with smooth borders and low internal echo density. Enhanced computed tomography (CT) showed a sausage-shaped pancreas without definitive metastasis to the surrounding lymph nodes and liver. Imaging of the pancreatic duct, including endoscopic retrograde pancreatography (ERP) and magnetic resonance cholangiopancreatography (MRCP), showed stenosis of the main pancreatic duct at the pancreatic head as well as a long segment of narrowing at the body and no dilatation at the tail. Tissues from these stenotic sites and open biopsy from pancreatic body showed infiltrating adenocarcinoma and dense fibrosis. To date, only a small number of reports have described pancreatic carcinoma accompanied with AIP. It is important to confirm diagnosis with histology in cases of suspicious autoimmune pancreatitis, even when the clinical images are compatible with AIP.
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan. h.matsubayashi@scchr.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Matsunaga
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.affiliation: Division of GI Oncology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fukutomi
authors.affiliation: Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Furukawa
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
keywords: Auto-antibody; Autoimmune pancreatitis; IgG4; Pancreatic carcinoma