Cystic Lesions in Autoimmune Pancreatitis
Autoimmune pancreatitis (AIP) can be chronic or recurrent, but frequently completely reversible after steroid treatment. A cystic lesion in AIP is a rare finding, and it can mimic a pancreatic cystic neoplasm. Difficulties in an exact diagnosis interfere with treatment, and surgery cannot be avoided...
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2015-11-01
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doaj-4374cec02b0c476aa14f8ecbf44b747c2020-11-24T21:43:42ZengKarger PublishersCase Reports in Gastroenterology1662-06312015-11-019336637410.1159/000441998441998Cystic Lesions in Autoimmune PancreatitisMacarena GompertzClaudia MoralesHernán AldanaJaime CastilloZoltán BergerAutoimmune pancreatitis (AIP) can be chronic or recurrent, but frequently completely reversible after steroid treatment. A cystic lesion in AIP is a rare finding, and it can mimic a pancreatic cystic neoplasm. Difficulties in an exact diagnosis interfere with treatment, and surgery cannot be avoided in some cases. We report the history of a 63-year-old male presenting with jaundice and pruritus. AIP was confirmed by imaging and elevated IgG4 blood levels, and the patient completely recovered after corticosteroid therapy. One year later, he presented with a recurrent episode of AIP with elevated IgG4 levels, accompanied by the appearance of multiple intrapancreatic cystic lesions. All but 1 of these cysts disappeared after steroid treatment, but the remaining cyst in the pancreatic head was even somewhat larger 1 year later. Pancreatoduodenectomy was finally performed. Histology showed the wall of the cystic lesion to be fibrotic; the surrounding pancreatic tissue presented fibrosis, atrophy and lymphoplasmacytic infiltration by IgG4-positive cells, without malignant elements. Our case illustrates the rare possibility that cystic lesions can be part of AIP. These pseudocysts appear in the pancreatic segments involved in the autoimmune disease and can be a consequence of the local inflammation or related to ductal strictures. Steroid treatment should be initiated, after which these cysts can completely disappear with recovery from AIP. Surgical intervention may be necessary in some exceptional cases.http://www.karger.com/Article/FullText/441998Intraductal papillary mucinous neoplasmAutoimmune pancreatitisNeoplastic cystic lesionPancreatic cancerPseudocyst |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Macarena Gompertz Claudia Morales Hernán Aldana Jaime Castillo Zoltán Berger |
spellingShingle |
Macarena Gompertz Claudia Morales Hernán Aldana Jaime Castillo Zoltán Berger Cystic Lesions in Autoimmune Pancreatitis Case Reports in Gastroenterology Intraductal papillary mucinous neoplasm Autoimmune pancreatitis Neoplastic cystic lesion Pancreatic cancer Pseudocyst |
author_facet |
Macarena Gompertz Claudia Morales Hernán Aldana Jaime Castillo Zoltán Berger |
author_sort |
Macarena Gompertz |
title |
Cystic Lesions in Autoimmune Pancreatitis |
title_short |
Cystic Lesions in Autoimmune Pancreatitis |
title_full |
Cystic Lesions in Autoimmune Pancreatitis |
title_fullStr |
Cystic Lesions in Autoimmune Pancreatitis |
title_full_unstemmed |
Cystic Lesions in Autoimmune Pancreatitis |
title_sort |
cystic lesions in autoimmune pancreatitis |
publisher |
Karger Publishers |
series |
Case Reports in Gastroenterology |
issn |
1662-0631 |
publishDate |
2015-11-01 |
description |
Autoimmune pancreatitis (AIP) can be chronic or recurrent, but frequently completely reversible after steroid treatment. A cystic lesion in AIP is a rare finding, and it can mimic a pancreatic cystic neoplasm. Difficulties in an exact diagnosis interfere with treatment, and surgery cannot be avoided in some cases. We report the history of a 63-year-old male presenting with jaundice and pruritus. AIP was confirmed by imaging and elevated IgG4 blood levels, and the patient completely recovered after corticosteroid therapy. One year later, he presented with a recurrent episode of AIP with elevated IgG4 levels, accompanied by the appearance of multiple intrapancreatic cystic lesions. All but 1 of these cysts disappeared after steroid treatment, but the remaining cyst in the pancreatic head was even somewhat larger 1 year later. Pancreatoduodenectomy was finally performed. Histology showed the wall of the cystic lesion to be fibrotic; the surrounding pancreatic tissue presented fibrosis, atrophy and lymphoplasmacytic infiltration by IgG4-positive cells, without malignant elements. Our case illustrates the rare possibility that cystic lesions can be part of AIP. These pseudocysts appear in the pancreatic segments involved in the autoimmune disease and can be a consequence of the local inflammation or related to ductal strictures. Steroid treatment should be initiated, after which these cysts can completely disappear with recovery from AIP. Surgical intervention may be necessary in some exceptional cases. |
topic |
Intraductal papillary mucinous neoplasm Autoimmune pancreatitis Neoplastic cystic lesion Pancreatic cancer Pseudocyst |
url |
http://www.karger.com/Article/FullText/441998 |
work_keys_str_mv |
AT macarenagompertz cysticlesionsinautoimmunepancreatitis AT claudiamorales cysticlesionsinautoimmunepancreatitis AT hernanaldana cysticlesionsinautoimmunepancreatitis AT jaimecastillo cysticlesionsinautoimmunepancreatitis AT zoltanberger cysticlesionsinautoimmunepancreatitis |
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