- 期刊
- OpenAccess
The Quandary of Autoimmune Pancreatitis and Pancreatic Ductal Adenocarcinoma: A Case Report and Review of IgG4 Immunostaining in a Cohort of Patients Receiving Neoadjuvant Chemotherapy
並列摘要
Introduction: Autoimmune pancreatitis (AIP) is an inflammatory disease whose clinical presentation can mimic that of pancreatic ductal adenocarcinoma (PDA). AIP can appear on imaging as a bulky, sausage-like pancreatic mass with biliary and pancreatic ductal obstruction, resembling the classic ＂double duct sign＂ appearance of PDA. A definitive preoperative diagnosis of AIP can be difficult because the two diseases (AIP and PDA) are similar in clinical presentation. Recent advances in serum marker evaluation such as IgG4 serum levels and immunostaining techniques have shown some promise in the differentiation of AIP from PDA. Case Report: ＂We report the case of a patient with a preoperative diagnosis of locally advanced PDA who was treated with neoadjuvant gemcitabine based chemotherapy followed by surgical resection, but whose postresection pathology was indicative of AIP and not PDA. To explore the possibility that the preresection gemcitabine-based chemotherapy had generated a complete pathological response and an inflammatory reaction of IgG4-Positive plasma cells, we studied the histology features and IgG4 plasma cell immunostaining characteristics of the pathology specimens of 14 patients with a diagnosis of PDA who were treated with neoadjuvant chemotherapy and surgical resection at our institution. Conclusion: Our results indicate that none of the patients treated with neoadjuvant chemotherapy had increased IgG4-Positive plasma cell immunostaining postoperatively, further supporting the diagnosis of AIP and not PDA in our patient.