November 12, 2014
Notes: Uomo, G
Patchen Dellinger, E
Forsmark, C E
Siriwardena, A K
Whitcomb, D C
Windsor, J A
Petrov, M S
Consensus Development Conference
Minerva Med. 2013 Dec;104(6):649-57.
Author Address: Internal Medicine Department, Cardarelli Hospital, Naples, Italy – email@example.com.
Reference Type: Journal Article
Record Number: 4806Author: Urata, T., Naito, Y., Izumi, Y., Takekuma, Y., Yokomizo, H., Nagamine, M., Fukuda, S., Notohara, K. and Hifumi, M.
Title: Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms
Journal: World J Gastroenterol
Date: Dec 21
Short Title: Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms
Alternate Journal: World journal of gastroenterology : WJG
ISSN: 2219-2840 (Electronic)
Accession Number: 24379640
Carcinoma, Pancreatic Ductal/*complications/diagnosis/surgery
Cholangiopancreatography, Magnetic Resonance
Diffusion Magnetic Resonance Imaging
Neoplasms, Cystic, Mucinous, and Serous/*complications/diagnosis/surgery
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.