Ghadir Mohammad-Reza, Sheikhesmaili Farshad, Attari Fatemeh, Safdari Reza, Ghanooni Amirhossein, Vaez-Javadi Maryam
Department of Internal Medicine, Qom University of Medical Sciences, Shahid Beheshti General Hospital, Qom, Iran.
J Med Case Rep. 2012 Jan 11;6:11. doi: 10.1186/1752-1947-6-11.
We report on a case of autoimmune pancreatitis presenting as pancreatic head cancer, which is extremely rare in Iran. Currently, on the PubMed database, no such cases exist.
A 70-year-old Iranian man presented with recurrent abdominal pain, jaundice and elevated bilirubin and alkaline phosphatase levels. An abdominal computed tomography scan revealed a heterogeneous presence in the pancreatic head as well as dilated intra- and extrahepatic bile ducts. A common bile duct stent had been inserted. Our patient was subsequently diagnosed with pancreatic head cancer.Due to his continued recurrent abdominal pain, our patient returned to the hospital. His levels of bilirubin, alkaline phosphatase and tumor markers were all normal but his immunoglobulin G4 and antinuclear antibodies were extremely high. A biopsy of the pancreatic head heterogeneity by endoscopic ultrasonography was performed.Pathologic samples showed fibrosis associated with lymphoplasmacytic infiltration and no evidence of malignancy. A diagnosis of autoimmune pancreatitis was confirmed, the bile duct stent removed, and an appropriate treatment plan was undertaken.
Autoimmune pancreatitis should be considered in suspected cases of pancreatic cancer. In these instances, a biopsy of the pancreas will help to differentiate between the two and prevent complications due to disease progression as well as unnecessary surgery.
我们报告一例表现为胰头癌的自身免疫性胰腺炎病例，这在伊朗极为罕见。目前，在PubMed数据库中，尚无此类病例。
一名70岁的伊朗男性出现反复腹痛、黄疸，胆红素和碱性磷酸酶水平升高。腹部计算机断层扫描显示胰头存在不均匀病变，肝内和肝外胆管扩张。已插入胆总管支架。我们的患者随后被诊断为胰头癌。由于他持续反复腹痛，患者再次入院。他的胆红素、碱性磷酸酶和肿瘤标志物水平均正常，但免疫球蛋白G4和抗核抗体极高。通过内镜超声对胰头不均匀病变进行活检。病理样本显示伴有淋巴浆细胞浸润的纤维化，无恶性证据。自身免疫性胰腺炎诊断得以确认，取出胆管支架，并采取了适当的治疗方案。
疑似胰腺癌病例应考虑自身免疫性胰腺炎。在这些情况下，胰腺活检有助于区分两者，并预防疾病进展导致的并发症以及不必要的手术。
