Moqran Sanae, Tahiri El Ousrouti Layla, Hammas Nawal, El Bouardi Nizar, Chbani Laila
Laboratory Medicine, Faculty of Medicine, Pharmacy and Dental Medicine, Fez, MAR.
Pathology, Hassan II University Hospital, Fez, MAR.
Cureus. 2024 Aug 14;16(8):e66879. doi: 10.7759/cureus.66879. eCollection 2024 Aug.
IgG4-related autoimmune pancreatitis (AIP) is a chronic inflammatory disease of the pancreas with a distinct histological feature. Its diagnosis remains challenging as some features overlap with pancreatic cancer. We present a case of IgG4-related AIP mimicking pancreatic cancer. A 70-year-old male patient presented with epigastric pain, radiating to the entire abdomen with an unquantified weight loss. Magnetic resonance cholangiopancreatography (MRCP) showed a mass with a 28 mm long axis, in the head of the pancreas with pancreatic duct dilatation. Thus, it was presumed to be a pancreatic neoplasm and pancreatic resection was undertaken without a definitive preoperative diagnosis. In terms of clinical presentation, imaging characteristics, and laboratory parameters, IgG4-related AIP can resemble pancreatic cancer. Thus, histopathological studies remain the gold standard for a definitive diagnosis that may show a diffuse lymphoplasmacytic infiltrate with storiform fibrosis. On immunohistochemistry, the majority of plasma cells are positive for IgG4 (>50 per high-power field (HPF)). In our case, the histologic diagnosis allowed us to suggest the diagnosis of IgG4-related AIP and the immunohistochemical diagnosis confirmed the diagnosis. It is critical to distinguish pancreatic cancer from IgG4-related AIP due to its completely different prognosis and therapy. Steroids are the first-line treatment that allow a reduction of risk of relapse; therefore, a misdiagnosis as a malignancy leads to inappropriate surgical interventions. In this case, a biopsy is recommended.
IgG4相关性自身免疫性胰腺炎（AIP）是一种具有独特组织学特征的胰腺慢性炎症性疾病。由于其某些特征与胰腺癌重叠，其诊断仍然具有挑战性。我们报告一例疑似胰腺癌的IgG4相关性AIP病例。一名70岁男性患者出现上腹部疼痛，放射至全腹，并伴有不明原因的体重减轻。磁共振胰胆管造影（MRCP）显示胰腺头部有一长轴为28 mm的肿块，伴有胰管扩张。因此，在未进行明确术前诊断的情况下，推测为胰腺肿瘤并进行了胰腺切除术。就临床表现、影像学特征和实验室参数而言，IgG4相关性AIP可能类似于胰腺癌。因此，组织病理学研究仍然是明确诊断的金标准，可能显示弥漫性淋巴浆细胞浸润伴束状纤维化。免疫组化显示，大多数浆细胞IgG4阳性（每高倍视野>50个）。在我们的病例中，组织学诊断提示IgG4相关性AIP的诊断，免疫组化诊断证实了该诊断。由于胰腺癌和IgG4相关性AIP的预后和治疗完全不同，因此区分两者至关重要。类固醇是一线治疗药物，可降低复发风险；因此，误诊为恶性肿瘤会导致不适当的手术干预。在这种情况下，建议进行活检。
