Hirano Kenji, Itoi Takanobu, Sasahira Naoki, Koyama Hiroto, Ihara Fumie
Department of Internal Medicine, Japan Community Healthcare Organization Tokyo Takanawa Hospital, Japan.
Department of Surgery, Japan Community Healthcare Organization Tokyo Takanawa Hospital, Japan.
Intern Med. 2021 Sep 1;60(17):2793-2797. doi: 10.2169/internalmedicine.6514-20. Epub 2021 Mar 22.
An 84-year-old man was referred to our hospital for a cystic lesion of the pancreatic head, swelling of the pancreatic tail and hilar biliary stricture, resulting in elevated liver enzyme levels. We suspected branch duct-type intraductal papillary mucinous neoplasm (IPMN) and type I autoimmune pancreatitis (AIP) associated with sclerosing cholangitis because of the high serum IgG4 levels. The main pancreatic duct on the tail side of the AIP lesion was moderately dilated. Although the biliary stricture and pancreatic swelling improved after prednisolone treatment, the pancreatic enzyme levels increased rapidly. The entire main pancreatic duct exhibited remarkable dilatation, which led to the diagnosis of mixed-type IPMN. The clinical characteristics of IPMN in the main pancreatic duct appear to have been initially masked by AIP.
一名84岁男性因胰头囊性病变、胰尾肿胀和肝门部胆管狭窄导致肝酶水平升高而被转诊至我院。由于血清IgG4水平较高，我们怀疑为分支导管型导管内乳头状黏液性肿瘤（IPMN）以及与硬化性胆管炎相关的I型自身免疫性胰腺炎（AIP）。AIP病变尾部侧的主胰管中度扩张。虽然泼尼松龙治疗后胆管狭窄和胰腺肿胀有所改善，但胰酶水平迅速升高。整个主胰管出现明显扩张，从而诊断为混合型IPMN。主胰管IPMN的临床特征最初似乎被AIP掩盖了。
