Witkiewicz Agnieszka K, Kennedy Eugene P, Kennyon Lawrence, Yeo Charles J, Hruban Ralph H
Department of Pathology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Hum Pathol. 2008 Oct;39(10):1548-51. doi: 10.1016/j.humpath.2008.01.021. Epub 2008 Jul 11.
An 80-year-old white man underwent pylorus-preserving pancreaticoduodenectomy after presenting with obstructive jaundice and a dilated biliary tree on cholangiopancreatography. Histologic evaluation of the specimen revealed synchronous autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) and infiltrating ductal adenocarcinoma of the pancreas. The mixed inflammatory infiltrate centered on the pancreatic ducts was associated with acinar loss, parenchymal fibrosis, and obliterative venulitis. Immunohistochemical labeling with an antibody to IgG4 revealed greater than 50 IgG4-positive plasma cells per high power field. Although not appreciated grossly, pancreatic intraepithelial neoplasia-3 and a neurotropic infiltrating poorly differentiated adenocarcinoma of the pancreas were also present. This case highlights the importance of carefully evaluating patients with autoimmune pancreatitis to rule out an underlying neoplasm and the importance of following those who were treated nonsurgically until the disease fully resolves.
一名80岁白人男性在出现梗阻性黄疸且胰胆管造影显示胆管树扩张后，接受了保留幽门的胰十二指肠切除术。对标本的组织学评估显示存在同步性自身免疫性胰腺炎（淋巴细胞浆细胞性硬化性胰腺炎）和胰腺浸润性导管腺癌。以胰管为中心的混合性炎性浸润与腺泡丢失、实质纤维化和闭塞性静脉炎相关。用抗IgG4抗体进行免疫组化标记显示，每高倍视野有超过50个IgG4阳性浆细胞。尽管大体上未被发现，但也存在胰腺上皮内瘤变-3和神经侵袭性浸润性低分化胰腺腺癌。该病例强调了仔细评估自身免疫性胰腺炎患者以排除潜在肿瘤的重要性，以及对非手术治疗患者进行随访直至疾病完全缓解的重要性。
