Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr-Jun;44(2):181-185.
doi: 10.12865/CHSJ.44.02.15. Epub 2018 Mar 27.

A Diagnostic Challenge: Pancreatic Cancer or Autoimmune Pancreatitis?

I M Cazacu  1   2 , A A L Chavez  1 , A Saftoiu  2 , T G Whitlow  1 , P Bhosale  3 , M S Bhutani  1
Affiliations

A Diagnostic Challenge: Pancreatic Cancer or Autoimmune Pancreatitis?

I M Cazacu et al. Curr Health Sci J. 2018 Apr-Jun.

Abstract

We report a rare case of seronegative autoimmune pancreatitis (AIP) that presented as a pancreatic focal lesion and was considered to be pancreatic cancer based on the clinical presentation and imaging findings. The endoscopic ultrasound-guided biopsies of the pancreatic mass revealed no malignant cells and the pancreatic swelling had become diffuse on repeat imaging. AIP was suspected and a trial of steroids was considered as a diagnostic and therapeutic method. The patient responded dramatically to corticosteroid treatment with resolution of symptoms and normal imagining and laboratory parameters. This case highlights the challenge in the diagnostic approach of a pancreatic mass.

Keywords: endoscopic ultrasound; endoscopic ultrasound-guided fine-needle aspiration; autoimmune pancreatitis; pancreatic cancer.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A. Axial contrast enhanced CT showing a hypoattenuating mass in the pancreatic head (arrow) abutting the SMV; B. Endoscopic ultrasound showing a hypoechoic, heterogenous pancreatic mass, with loss of interface with superior mesenteric vein; C. Endoscopic ultrasound-guided fine needle aspiration of the pancreatic mass using a 25 gauge needle
Figure 2
Figure 2
A. Axial CT showing diffuse enlargement of the pancreas due to autoimmune pancreatitis with peripancreatic inflammatory changes (arrow); B. Coronal post-contrast CT scan shows diffuse thickening of the common bile duct (arrow) due to autoimmune cholangiopathy
Figure 3
Figure 3
MRI T1 post contrast T1 weighted sequence showing normal pancreas (arrow)
See this image and copyright information in PMC

References

    1. Klöppel G, Detlefsen S, Chari ST, Longnecker DS, Zamboni G. Autoimmune pancreatitis: the clinicopathological characteristics of the subtype with granulocytic epithelial lesions. Journal of gastroenterology. 2010;45(8):787–793. - PubMed
    1. Zhang L, Chari S, Smyrk TC, Deshpande V, Klöppel G, Kojima M, Liu X, Longnecker DS, Mino-Kenudson M, Notohara K. Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas. 2011;40(8):1172–1179. - PubMed
    1. Hart PA, Zen Y, Chari ST. Reviews in basic and clinical gastroenterology and hepatology. Gastroenterology. 2015;149:39–51. - PubMed
    1. Kamisawa T, Tabata T, Hara S, Kuruma S, Chiba K, Kanno A, Masamune A, Shimosegawa T. Recent advances in autoimmune pancreatitis. Frontiers in physiology. 2012;3:374–374. - PMC - PubMed
    1. Sarles H, Sarles J-C, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas—an autonomous pancreatic disease. The American journal of digestive diseases. 1961;6(7):688–698. - PubMed

LinkOut - more resources