Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Case Report Volume 6 Issue 2

Pancreatic Pseudotumour in Seronegative Autoimmune Pancreatitis: A Rare case in the Caribbean

Elizabeth Guelmo-Daisley*, Shiva Sarwan, Ariadne Saunders and Osei Fraser

Department of Surgery, Port-Of-Spain General Hospital, Trinidad

*Corresponding Author: Elizabeth Guelmo-Daisley, Department of Surgery, Port-Of-Spain General Hospital, Trinidad.

Received: December 01, 2021; Published: January 17, 2022

Abstract

Background: Autoimmune pancreatitis (AIP) is commonly found in Asia and Japan but its incidence in most of the western world is yet to be determined. There are two histologically distinct forms of the disease: type 1 and type 2 AIP. AIP may appear clinically and radiologically similar to pancreatic adenocarcinoma, but with fundamentally different treatment strategies.

Case Presentation: A non-alcoholic 42-year-old female with no medical issues presented with painless and progressive clinical and biochemical obstructive jaundice. Initial focused hepatobiliary ultrasound excluded cholelithiasis, and CECT and MRI abdomen with contrast/MRCP imaging of the biliary tree was highly suggestive of a pancreatic head neoplasm. Her Ca 19.9 levels were elevated and her IgG4 serology was normal. A pancreaticoduodenectomy was done. Histological examination of the specimen revealed nil evidence of pancreatic adenocarcinoma, but a robust lymphoplasmacytic inflammatory infiltrate with storiform fibrosis in keeping with autoimmune pancreatitis.

Discussion: Despite the existence of and adherence to robust AIP international guidelines, pancreatic pseudotumours represent a distinct clinical entity that is difficult to distinguish from pancreatic adenocarcinoma based on clinical, radiological and serological investigations. Thus, the incidence of patients having unnecessary surgery for AIP due to misdiagnosis remains around 9.9%, with the inherent associated morbidity [1].

Keywords: Autoimmune Pancreatitis; Biliary Tree; Pancreatic Adenocarcinoma

References

  1. de Castro SM., et al. “Incidence and characteristics of chronic and lymphoplasmacytic sclerosing pancreatitis in patients scheduled to undergo a pancreatoduodenectomy”. HPB (Oxford)1 (2010): 15-21.
  2. Khandelwal A., et al. “Autoimmune Pancreatitis: an update”. Abdominal Radiology5 (2020): 1359-1370.
  3. Masamune A., et al. “Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2016”. Journal of Gastroenterology4 (2020): 462-470.
  4. Madhani K and Farrell JJ. “Autoimmune Pancreatitis: An Update on Diagnosis and Management”. Gastroenterology Clinics of North America 1 (2016): 29-43.
  5. Tassi E., et al. “Carcinoembryonic antigen – specific but not antiviral CD4+ T cell immunity is impaired in Pancreatic carcinoma patients”. Journal of Immunology9 (2008): 6595-6603.
  6. Poddighe D. “Autoimmune pancreatitis and pancreatic cancer: Epidemiological aspects and immunological considerations”. World Journal of Gastroenterology 25 (2021): 3825-3836.
  7. Macinga P., et al. “Simultaneous occurrence of autoimmune pancreatitis and pancreatic cancer in patients resected for focal pancreatic mass”. World Journal of Gastroenterology 12 (2017): 2185- 2193.

Citation

Citation: Elizabeth Guelmo-Daisley., et al. “Pancreatic Pseudotumour in Seronegative Autoimmune Pancreatitis: A Rare case in the Caribbean”.Acta Scientific Medical Sciences 6.2 (2022): 100-104.

Copyright

Copyright: © 2022 Elizabeth Guelmo-Daisley., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.403

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