Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms |
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Authors: | Takahiro Urata Yoshiki Naito Yoshihiro Izumi Yoshi Takekuma Hiroshi Yokomizo Michiko Nagamine Seiji Fukuda Kenji Notohara Michio Hifumi |
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Institution: | Department of Gastroenterology,Japanese Red Cross Kumamoto Hospital,Kumamoto 861-8520,Japan;Department of Pathology,Kurume University School of Medicine,Kurume City,Fukuoka 830-0011,Japan;Department of Surgery,Japanese Red Cross Kumamoto Hospital,Kumamoto 861-8520,Japan;Department of Pathology,Japanese Red Cross Kumamoto Hospital,Kumamoto 861-8520,Japan;Department of Anatomic Pathology,Kurashiki Central Hospital,Kurashiki City,Okayama 701-01,Japan |
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Abstract: | A 70-year-old woman was found to have 2 cystic lesions in the head of the pancreas on abdominal ultrasonography during a routine medical examination. Endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography showed multilocular cysts in the head of the pancreas without dilation of the main pancreatic duct. The patient was followed-up semiannually with imaging studies for suspected branch duct-type intraductal papillary mucinous neoplasm (IPMN). At 3 years after initial presentation, hypoechoic lesions were observed around each pancreatic cyst by EUS. Diffusion-weighted imaging showed high-intensity regions corresponding to these lesions. Therefore, a diagnosis of invasive carcinoma derived from IPMN could not be excluded, and subtotal stomach-preserving pancreaticoduodenectomy was performed. The macroscopic examination of the surgical specimen showed whitish solid masses in the head of the pancreas, with multilocular cysts within each mass. Microscopically, each solid mass consisted of inflammatory cells such as lymphocytes and plasma cells. Furthermore, immunochemical staining revealed immunoglobulin G4-positive cells, and many obliterating phlebitides were observed. The cysts consisted of mucus-producing epithelial cells and showed a papillary growth pattern. Based on these findings, we diagnosed multiple localized type 1 autoimmune pancreatitis occurring only in the vicinity of the branch duct-type IPMN. |
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Keywords: | Autoimmune pancreatitis Intraductal papillary mucinous neoplasm Immunoglobulin G4 Endoscopic ultrasonography Diffusion-weighted imaging |
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