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Glinka J, Calderón F, de Santibañes M, Hyon SH, Gadano A, Mullen E, Pol M, Spina J, de Santibañes E. Early pancreatic cancer in IgG4-related pancreatic mass: A case report. World J Gastrointest Surg 2019; 11:443-448. [PMID: 31879536 PMCID: PMC6912071 DOI: 10.4240/wjgs.v11.i12.443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/18/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND IgG4-related disease can manifest diversely, including autoimmune pancreatitis and IgG4-related cholangiopathy. We are reporting a very unusual cause of pancreatic cancer triggered in a previously unknown IgG4-related disease.
CASE SUMMARY A 75-year-old man was diagnosed with a 43 mm × 33 mm pancreatic head tumor after consulting for abdominal pain and jaundice. A pancreaticoduodenectomy was carried out uneventfully, and the histopathology report showed an early stage of acinar-cell pancreatic cancer. The patient reconsulted on the 30th postoperative day with fever, jaundice and asthenia. Magnetic resonance cholangiopancreatography evidenced an extense bile duct stricture. A percutaneous biliary drainage proved to be ineffective, even after exchanging it with larger bore drainage. Reviewing the surgical specimen, features compatible with IgG4-related disease were observed. Consequently, empiric treatment with steroids was initiated achieving excellent results.
CONCLUSION IgG4-related disease may cause chronic inflammation of the pancreas and can condition pancreatic malignancies.
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Affiliation(s)
- Juan Glinka
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Francisco Calderón
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Martín de Santibañes
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Sung Ho Hyon
- Department of General Surgery, Image Guided Minimally Invasive Surgery Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Adrián Gadano
- Hepatology Section, Hospital Italiano Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Eduardo Mullen
- Department of Surgical Pathology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Melina Pol
- Department of Surgical Pathology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Juan Spina
- Department of Radiology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
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Euch ME, Hddad S, Mahfoudhi M, Maktouf H, Ben Hamida F, Jaziri F, Ben Abdelghani K, Turki S, Ben Abdallah T. A Case of Type 1 Autoimmune Pancreatitis (AIP), a Form of IgG4-Related Disease (IgG4-RD). AMERICAN JOURNAL OF CASE REPORTS 2017; 18:822-825. [PMID: 28736430 PMCID: PMC5539804 DOI: 10.12659/ajcr.904263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/28/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Type 1 autoimmune pancreatitis (AIP), also known as lymphoplasmacytic sclerosing pancreatitis (LPSP), is a rare cause of chronic pancreatitis, characterized by a fibro-inflammatory process. However, patients with AIP may have a good response to corticosteroid therapy. We describe a Tunisian patient with AIP that was confirmed to be an IgG4-related disease (IgG4-RD). CASE REPORT We describe a case of a 70-year-old man who was admitted to hospital for obstructive jaundice and abdominal pain. Serum liver function tests were abnormal and upper abdominal computed tomography (CT) imaging showed diffuse pancreatic swelling and strictures of the main pancreatic duct without any focal lesion. Pancreatico-biliary magnetic resonance imaging (MRI) showed a thickened rim surrounding the pancreatic duct Serum IgG4 levels were elevated, resulting in a diagnosis of IgG4-related AIP. The patient showed a good clinical, biochemical, and radiological response following steroid therapy in combination with azathioprine. CONCLUSIONS The diagnostic workup of IgG4-RD is complex and usually requires a combination of clinical examination, imaging, and serological analysis. As this case report has demonstrated, IgG4-RD should be considered in patients who present with pancreatitis or AIP, because of the favorable response to steroid therapy, particularly when treatment is initiated early.
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Affiliation(s)
- Mounira El Euch
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Souha Hddad
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Madiha Mahfoudhi
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Maktouf
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Khaoula Ben Abdelghani
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Sami Turki
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
| | - Taïeb Ben Abdallah
- Department of Internal Medicine ‘A’, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
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