A case of concurrent pancreatic intraepithelial neoplasia and type 1 autoimmune pancreatitis with marked pancreatic duct dilatation
A case of concurrent pancreatic intraepithelial neoplasia and type 1 autoimmune pancreatitis with marked pancreatic duct dilatation
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胰腺上皮内瘤变并发1型自身免疫性胰腺炎伴胰管明显扩张1例
DOI：
10.1007/s12328-016-0666-3
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发表时间：
2016
影响因子：
1
通讯作者：
Nobuyuki Ohike
中科院分区：
文献类型：
--
作者：
Y. Takano;Masatsugu Nagahama;Eiichi Yamamura;N. Maruoka;K. Yokomizo;H. Mizukami;Jun‐ichi Tanaka;Nobuyuki Ohike
病例患者为一名先前健康的82岁男性。体检时腹部超声显示主胰管扩张，患者被转至我院进一步检查。增强计算机断层扫描（CT）显示胰腺头体过渡区低密度肿块20mm。磁共振胰胆管造影（MRCP）显示主胰管及体尾分支明显扩张。超声内镜检查发现一形状不规则的低回声肿块，与胰管狭窄面积一致。行内镜超声引导下细针穿刺（EUS-FNA）及胰液细胞学检查；然而，没有发现恶性肿瘤。血清IgG4水平升高至299 mg/dL。怀疑为胰头癌，行胰十二指肠切除术。肉眼可见胰管狭窄部位有一边界模糊的白色肿块，胰头呈斑状脂肪替代。病理上，白色肿块内可见大量igg4阳性浆细胞，呈故事状纤维化，伴梗阻性静脉炎，诊断为1型自身免疫性胰腺炎（AIP）。此外，分散的低-高级别胰腺上皮内瘤变病变在整个胰腺头部可见，与AIP病变分开。这是一个有趣的病例，表明AIP与胰腺癌之间存在关联。我们报告的情况下，检讨相关文献。
The case patient was a previously healthy 82-year-old male. Abdominal ultrasound during a medical check-up revealed a dilatation of the main pancreatic duct, and the patient was referred to our hospital for closer examination. Contrast-enhanced computed tomography (CT) revealed a low-density mass of 20 mm in the pancreatic head–body transitional area. Magnetic resonance cholangiopancreatography (MRCP) revealed marked dilatation of the main pancreatic duct and branches in the body–tail. On endoscopic ultrasonography (EUS), a hypoechoic mass with irregular shape was detected, which was consistent with the area of pancreatic duct stenosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and pancreatic juice cytology were performed; however, there were no malignant findings. Serum IgG4 levels had increased to 299 mg/dL. Cancer of the pancreatic head was suspected and a pancreaticoduodenectomy was thus performed. Macroscopic findings included a white mass with indistinct border in the constricted part of the pancreatic duct and mottled fatty replacement of the pancreatic head. Pathologically, a large amount of IgG4-positive plasma cells was found in the white mass, with storiform fibrosis and obstructive phlebitis, which led to the diagnosis of type 1 autoimmune pancreatitis (AIP). Furthermore, scattered low–high grade pancreatic intraepithelial neoplasia lesions were observed throughout the pancreatic head, separately from the AIP lesion. This is an interesting case that suggests an association between AIP and pancreatic cancer. We report the case with a review of relevant literature.
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