scholarly journals Focal IgG4-related autoimmune pancreatitis with distal choledochal adenocarcinoma: a rare case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Han Wang ◽  
Lan Yao ◽  
Ligang Wang ◽  
Xixi Sun ◽  
Bin Huang
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Autoimmune Pancreatitis ◽  
Extrahepatic Bile Duct ◽  
Pancreatic Head ◽  
Research Progress ◽  
Distal Common Bile Duct ◽  
Radiographic Findings ◽  
Pancreatic Biopsy ◽  
Pancreatic Involvement

Abstract Background Autoimmune pancreatitis (AIP) is a rare disease that manifests as pancreatic involvement in systemic IgG4-related disease (IgG4-RD), a special type of chronic pancreatitis caused by autoimmune abnormalities. The main imaging manifestations of IgG4-related AIP consist of diffuse or localized pancreatic enlargement and irregular pancreatic duct narrowing. The diagnosis of AIP is challenging because it can present with focal lesions, similar to radiologically bile duct cancer or pancreatic cancer. Case presentation A 55-year-old male patient was admitted with painless jaundice and multiple radiographic findings of pancreatic head mass, as well as intrahepatic and extrahepatic bile duct dilatation. Various imaging methods indicated pancreatic cancer. However, the endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) and a laparoscopic pancreatic biopsy suggested an IgG4-related AIP. After one month, magnetic resonance imaging showed that the lesion had slightly grown. Combined with CA19-9 and other indexes, the possibility of malignancy was high and there were still surgical indications. The pathological analysis following a pancreaticoduodenectomy revealed poorly differentiated adenocarcinoma in the distal common bile duct. Conclusion To date, few reports have described pancreatic or extrapancreatic malignancies in AIP patients, and no association between AIP and bile duct adenocarcinoma has been previously confirmed. This case discuss the differentiation between AIP and malignancy, recent research progress, and the correlation between the two diseases, highlights the importance of carefully evaluating patients with AIP to rule out potential tumors, as well as the critical need for follow up treatment.

scholarly journals Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review

2018 ◽  
Vol 46 (4) ◽  
pp. 1657-1665 ◽  
Author(s):  
Wen-Ling Hsu ◽  
Shu-Min Chang ◽  
Pei-Yin Wu ◽  
Chin-Chuan Chang
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Elevated Serum ◽  
Pancreatic Head ◽  
Corticosteroid Treatment ◽  
Cancer Case ◽  
Pancreatic Lesion ◽  
Immunoglobulin G4 ◽  
Positron Emission ◽  
Serum Igg4

Autoimmune pancreatitis (AP) is a rare autoimmune pancreatic manifestation of systemic immunoglobulin G4 (IgG4)-related sclerosing disease. Distinguishing between AP and pancreatic cancer is crucial because the clinical courses, treatments, and prognoses of these two disease entities are quite different. We herein report a case involving a 52-year-old man with subacute epigastralgia who visited our hospital for evaluation of a suspicious pancreatic mass found during esophagogastroduodenoscopy. Enhanced computed tomography (CT) revealed an enlarged lesion in the pancreatic head with encasement of hepatic vessels. The lesion also exhibited increased 18F-fluorodeoxyglucose accumulation on positron emission tomography/CT imaging, which was highly suggestive of pancreatic cancer. After open biopsy, morphologic examination showed an inflammatory infiltrate in the pancreas, which was compatible with chronic sclerotic pancreatitis. Further laboratory tests revealed an elevated serum IgG4 level, and the diagnosis of sclerotic pancreatitis was then confirmed. After corticosteroid treatment, the pancreatic lesion showed shrinkage on follow-up CT, and the serum IgG4 titer decreased to the normal range. This case suggests that clinicians should be familiar with the clinical presentations and diagnostic criteria of AP versus pancreatic cancer. An awareness of the differences between these diseases may avoid misdiagnosis and unnecessary surgical intervention.

scholarly journals When It Doesn't Fit: Congenital Anomalies of the Choledochus

2020 ◽  
Vol 08 (01) ◽  
pp. e86-e89
Author(s):  
Helena Reusens ◽  
Mark Davenport
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Resected Specimen ◽  
Cystic Dilatation ◽  
Left Hepatic Duct ◽  
Distal Common Bile Duct

Abstract Introduction Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1–5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. Case Report 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. Case Report 2 A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Result Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Conclusions Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.

scholarly journals A Case of Pancreatic Cancer in the Setting of Autoimmune Pancreatitis with Nondiagnostic Serum Markers

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Manju D. Chandrasegaram ◽  
Su C. Chiam ◽  
Nam Q. Nguyen ◽  
Andrew Ruszkiewicz ◽  
Adrian Chung ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Portal Vein ◽  
Autoimmune Pancreatitis ◽  
Squamous Metaplasia ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Serum Markers ◽  
Normal Serum ◽  
Serum Igg4 ◽  
Ca 19.9

Background. Autoimmune pancreatitis (AIP) often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP.Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a “sausage-shaped” pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS-) guided fine-needle aspiration (FNA) of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas.Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.

scholarly journals Endoscopic ultrasonography-guided cholecystogastrostomy in a patient with pancreatic cancer: the first case in Colombia (with video)

2020 ◽  
Vol 35 (4) ◽  
pp. 527-532
Author(s):  
Renzo Pinto-Carta ◽  
Jaime Solano Mariño ◽  
Luis Felipe Cabrera Vargas ◽  
Erika Johana Benito Flórez
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Third World ◽  
Extrahepatic Bile Duct ◽  
Bile Leakage ◽  
Current Treatment ◽  
Curative Intent ◽  
Palliative Intent ◽  
First Case ◽  
Duodenal Invasion

The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent, the surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia a third-world country in Latin America of a cholecystogastrostomy guided by EUS in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT stent AXIOS; Xlumena Inc., Mountain View, CA, USA) 15mm x 10mm.EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc., Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.

scholarly journals SEVERE COVID-19 IN PATIENT AT EARLY POSTOPERATIVE PERIOD AFTER WHIPPLE’S OPERATION WITH MARGINAL PORTAL VEIN RESECTION

2021 ◽  
pp. 79-83
Author(s):  
V. KOPCHAK ◽  
A MAZUR ◽  
L. PERERVA ◽  
О. KHOMENKO ◽  
L. MAKSYMENKO ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Portal Vein ◽  
Pancreatic Head ◽  
Early Postoperative Period ◽  
Distal Common Bile Duct ◽  
Early Activation ◽  
Surgery Patient ◽  
Whipple’S Operation ◽  
Whipple's Operation

Introduction. Pancreatoduodenectomy (PDR or Whipple’s operation) remains the only effective radical method of surgery for tumors of the pancreatic head, distal common bile duct and Vater’s papilla. The most frequent complications of the early postoperative period are: gastrostasis, pancreatic fistula, postoperative bleeding and pulmonary complications. According to World Health Organization (WHO) and reviews, severe COVID-19 usually occurs in older age patients, and in patients with oncological diseases. Case description. Patient V., 64 years old, due to a tumor of the head of the pancreas with invasion of the distal common bile duct and the development of obstructive jaundice, underwent PDR. Histopathologically, ductal adenocarcinoma of the pancreatic head, G-2, was confirmed. The PDR operation was performed within healthy tissues, which was confirmed by histopathology. On the second day after surgery, patient was admitted to ICU because of respiratory failure, the SARS-CoV-2 antigen test was positive, we suggest that the patient was in the latent period of COVID-19 disease during the surgery. Patient received hormone therapy, anticoagulants in therapeutic doses, O2-therapy. On the 5th day, because of severe ARDS, the patient was intubated, on the 7th day - convalescent plasma transfused (1 dose). On the 9th day, a tracheostomy was applied for airways care and early activation. Respiratory support was provided twelve days. Patient received early activation, exercises, as well as early enteral nutrition. After ICU discharge, patient’s condition was complicated by the gastro-intestinal bleeding, blood transfusion and embolization of the dorsal pancreatic artery were performed. On the day 66th after surgery patient was discharged home in satisfactory condition. Conclusion. General care and early activation of the patient within early tracheostomy, convalescent plasma usage and the well-coordinated work of the surgical and anesthesiological teams allows timely identification and elimination of early postoperative complications after Whipple’s operation with marginal resection of the portal vein.

Lymphatic pathway around the pancreatic head and extrahepatic bile duct: evaluation using MR imaging at 3.0-T

2015 ◽  
Vol 40 (6) ◽  
pp. 1617-1628 ◽  
Author(s):  
Yasunari Yamada ◽  
Hiromu Mori ◽  
Shunro Matsumoto ◽  
Maki Kiyonaga ◽  
Michiaki Sai ◽  
...  
Keyword(s):  
Bile Duct ◽  
Mr Imaging ◽  
Extrahepatic Bile Duct ◽  
Pancreatic Head ◽  
3.0 T ◽  
Lymphatic Pathway

scholarly journals Involvement of mediastinal/intra.abdominal lymph nodes, spleen, liver, and left adrenal in presumed isolated pancreatic tuberculosis: An endoscopic ultrasound study

2015 ◽  
Vol 06 (01) ◽  
pp. 015-018 ◽  
Author(s):  
Surinder S. Rana ◽  
Vishal Sharma ◽  
Ravi Sharma ◽  
Deepak K. Bhasin
Keyword(s):  
Pancreatic Cancer ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Pancreatic Head ◽  
Left Lobe ◽  
Normal Morphology ◽  
Pancreatic Tuberculosis ◽  
Ultrasound Study ◽  
Pancreatic Involvement ◽  
Hypoechoic Mass

AbstractBackground: Isolated pancreatic tuberculosis is very rare and closely mimics pancreatic cancer. Extra pancreatic involvement is very rare and has been rarely reported. Aim: Study the involvement of mediastinal/intra-abdominal lymph nodes, spleen, liver, and left adrenal in patients of isolated pancreatic tuberculosis using endoscopic ultrasound (EUS). Patients and Methods: Retrospective analysis of the records of 16 patients (12 males; mean age 37.8 ± 9.3 years) with pancreatic tuberculosis seen over last 4 years was done. Results: All 16 patients had a well-defined predominantly hypoechoic mass lesion in the pancreatic head and 7/16 (43%) patient had isolated pancreatic tuberculosis with no lymphadenopathy or extrapancreatic involvement. Nine (57%) patients had involvement of the peripancreatic lymph nodes and 6 (38%), 3 (19%), and 2 (13%) patients had celiac, periportal, and mediastinal nodes involvement, respectively. The diameter of the lymph nodes ranged from 1.2 cm to 2.6 cm with celiac lymph nodes being the largest. The left adrenal had normal morphology on EUS in all patients. The spleen and left lobe of the liver were also normal on EUS. Conclusions: Extra pancreatic involvement is seen in up to one-third of patients with presumed isolated pancreatic tuberculosis with involvement of peri-pancreatic and celiac lymph nodes being the commonest.

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