Autoimmune pancreatitis diagnosed after pancreatoduodenectomy and successfully treated with low-dose steroid |
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Authors: | Watanabe Masato Yamaguchi Koji Kobayashi Kiichiro Konomi Hiroyuki Nakamura Masafumi Mizumoto Kazuhiro Tsuneyoshi Masazumi Tanaka Masao |
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Institution: | (1) Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;(2) Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan |
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Abstract: | A 69-year-old woman presented with obstructive jaundice and a 30-mm hypoechoic mass in the pancreatic head on ultrasonography.
Magnetic resonance imaging (MRI) revealed enlargement of the pancreatic head with dilatation of the upstream main pancreatic
duct and no dilatation of the proximal biliary tree. Endoscopic retrograde pancreatography showed a localized irregular narrowing
of the main pancreatic duct in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy (PPPD) was performed under
the diagnosis of pancreatic head cancer. Histopathological examination showed fibrosis with lymphoplasmacytic infiltration,
suggesting the diagnosis of autoimmune pancreatitis (AIP). Serum IgG concentration was within normal limits immediately after
the operation but was elevated 4 months later, when MRI showed enlargement of the remnant pancreas, with a peripheral rim
of low intensity. Oral administration of prednisolone was initiated, at a dose of 5 mg/day. The serum IgG concentration declined
and MRI showed improvement of the pancreatic enlargement and the disappearance of the peripheral rim. AIP has not relapsed
for 1 year so far, with the patient being kept on 5 mg/day prednisolone. This communication reports a patient with AIP showing
an interesting clinical course. |
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Keywords: | Autoimmune pancreatitis Pancreatoduodenectomy Steroid |
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