Gill Meenu, Brar Komal, Godara Rajesh, Bhargava Shilpi, Sachdeva Bhawna, Sen Rajeev, Jain Promil
Department of Pathology, Pt. B D Sharma PGIMS, Rohtak, India.
Department of Surgery, Pt. B D Sharma PGIMS, Rohtak, India.
Ann Med Surg (Lond). 2019 Jul 28;45:82-85. doi: 10.1016/j.amsu.2019.07.026. eCollection 2019 Sep.
Autoimmune pancreatitis (AIP) is a rare form of chronic inflammatory pancreatic disease secondary to an underlying autoimmune mechanism. It is now considered as pancreatic manifestation of IgG4 related disease, which is a multisystem disease.
We are reporting a patient who presented with obstructive jaundice and mass head of pancreas on Computed Tomography (CT) scan. Considering a strong clinical suspicion of pancreatic cancer, Whipple procedure was done. Histopathological report revealed intense lymphoplasmacytic infiltrate and fibrosis with collagenisation, so possibility of AIP was suggested. Serum IgG4 levels were advised and found to be increased. Diagnosis of AIP was made and patient responded to steroids.
Pre-operative core biopsy of the pancreas and Serum IgG4 levels are sufficient to make the diagnosis and resection is usually not recommended in AIP.
Awareness of the entity and use of ancillary techniques in making the pre-operative diagnosis could have saved the patient from an extensive surgical procedure.
自身免疫性胰腺炎（AIP）是一种继发于潜在自身免疫机制的罕见慢性炎症性胰腺疾病。它现在被认为是IgG4相关疾病的胰腺表现，而IgG4相关疾病是一种多系统疾病。
我们报告一名患者，其在计算机断层扫描（CT）上表现为梗阻性黄疸和胰腺头部肿块。考虑到强烈怀疑为胰腺癌，遂进行了胰十二指肠切除术。组织病理学报告显示有密集的淋巴浆细胞浸润和伴有胶原化的纤维化，因此提示有AIP的可能性。建议检测血清IgG4水平，结果发现其升高。确诊为AIP，患者对类固醇治疗有反应。
胰腺术前核心活检和血清IgG4水平足以做出诊断，AIP通常不建议进行手术切除。
认识该疾病实体并在术前诊断中使用辅助技术本可使患者避免接受广泛的外科手术。
