16 September 2024
: Case report 
Focal Autoimmune Pancreatitis Morphologically Mimicking Pancreatic Cancer: A Case Report and Literature Review
Challenging differential diagnosis
Daniel Paramythiotis1ADEF, Eleni Karlafti23ABCDEF*, Krystallenia Siniosoglou1BCDE, Dimitrios Tsavdaris1E, Ioanna Abba Deka
4BDE, Georgia Raptou4DE, Xanthippi G. Mavropoulou5BD, Elizabeth Psoma5BD, Stavros Panidis1BD, Antonios Michalopoulos1ABD
DOI: 10.12659/AJCR.944286
Am J Case Rep 2024; 25:e944286
Table 1. Review of 18 studies published in the last 11 years on postoperative cases with autoimmune pancreatitis.
| Study (study period) [Ref] | Study cohort | AIP type | Symptoms | Weight loss | IgG4 |
|---|---|---|---|---|---|
| Detlefsen, 2012 (1987–2010) []20 | 114 patients with AIP | Type 1: 63 (55.3%)Type 2: 51 (44.7%) | UN | UN | Available in 29 patients (25.4%) (+) type 1 (Postoperative): 12/18 (66.7%) type 2: 1/11 (9.1%) |
| van Heerde, 2012 (2000–2009) []15 | 7 patients with AIP among 274 PDs (2.6%) | type 1: 2 (28,5%)type 2: 4 (57.2%) | Jaundice (86%), weight loss, Pain moderate/severe (29%), Recent onset diabetes (29%) | Mean weight loss 2.7 kg | (+) 1/3 (preoperational) |
| Yurci, 2013 (1990–2012) []16 | 47 patients with AIP, 24 underwent surgery | type 1: 29 (74.3%)type 2: 7 (17.9%) | Abdominal pain 29 (61.7%), Acute pancreatitis 19 (40.4%), Weight loss 28 (59.6%) | UN | Available in 21 patients, 0–139: 10 patients (47.6%), 140–279: 4 patients (19.0%), ≥280: 7 patients (33.3%) |
| Miura, 2013 (1990–2010) []14 | 13 patients with AIP in comparison to 29 patients with CP | type 1 (100%) | Abdominal pain (46%), Jaundice (23%) | UN | (+) in (Preoperational), (+) in (Post Operational) |
| Vitali, 2014 (2005–2011) []17 | 11 patients with AIP among 373 surgical operations for pancreatic cancer | type 1: 8type 2: 3 | Abdominal pain (64%), Weight loss (64%), Jaundice (36%), Acute pancreatitis (27%) | 59%, (range 13.7–9.4 kg) | UN |
| Macinga, 2017 (2000–2013) []18 | 15 patients with AIP among 295 patients who underwent surgery | type 1: 6type 2: 9 | Weight loss (80%), Jaundice (47%), Diabetes (33%) | AIP: 8,5kg (range 3–12), AIP +PC: 15.5 (range 8–50) | Normal range (preoperative): 100% (from the total 3 patients with available results) |
| Dickerson, 2019 (1997–2016) []21 | 45 patients with AIP, 27 underwent surgery | type 1: 16type 2: 9 | UN | UN | (+) 2/11 |
| Seki, 2023 (1979–2018) []19 | 19 patients with AIP | type 1: 18type 2: 1 | Epigastralgia (n=4, 21%), Jaundice (n=3, 15,7%), Backache (n=2, 10,5%) | UN | Measured in 5 patients, (+) in 3 patients |
| Ikeura et al, 2014 []26 | 30 patients with AIP | Type 1: 23Type 2: 7 | Jaundice 17Abdominal pain 11Weight loss 10 | UN | 17% >2× upper limit of normal value 39% 1–2× upper limit of normal value |
| Wojcicki et al, 2015 []27 | 9 patients with AIP among 469 patients who underwent surgery | Type 1: 8Type 2: 1 | Jaundice 16 (47.06%), Pain 18 (52.94%), Weight loss 16 (47.06%) | UN | UN |
| Kimura et al, 2014 []25 | 6 patients with AIP type 1, underwent surgery | 100% AIP type 1 | 3 Epigastralgia2 Jaundice | UN | 4 patients had an elevated level, 0–139: 0 patients, 140–279: 3 patients, ≥280: 1 patient |
| Zhang et al, 2015 (2003–2012) []23 | 16 patients with AIP among 271 patients who underwent surgery | Type 1: 12 | 6 Emaciation7 Jaundice7 Abdominal pain | UN | 12 patients had an elevated level |
| Clark et al, 2013 (1986–2011) []31 | 74 patients with AIP who underwent surgery | type 1: 34type 2: 29 | 25 Pancreatitis34 Jaundice33 Weight loss | UN | Median serum IgG4 of 64 mg/d for 10 patients |
| Ünalp et al, 2012 (2001–2010) []28 | 10 patients with AIP type 1, underwent surgery | 100% AIP type 1 | 7 Jaundice1 Abdominal pain | UN | Not examined |
| Zhang et al, 2013 (1990–2010) []24 | 10 patients with AIP among 105 patients who underwent surgery | type 1: 7type 2: 3 | UN | UN | 7 patients had an elevated level |
| Nikolic et al, 2022 (2001–2020) []22 | 35 patients with AIP who underwent surgery | type 1: 28type 2: 7 | 15 Jaundice17 Weight loss17 Abdominal pain | UN | 7 patients had an elevated level |
| Vujasinovic et al, 2018 (2004–2018) []29 | 71 patients with AIP, 20 underwent surgery | type 1: 62type 2: 9 | 25 Jaundice28 Weight loss and Abdominal pain | UN | 27 patients had an elevated level |
| Tran et al, 2012 (2000–2010) []30 | 6 patients with AIP among 65 patients who underwent PD | 100% AIP type 1 | 6 Jaundice5 Weight loss4 Abdominal pain | 15 kg: 2 patients25 kg: 2 patients30 kg: 1 patient | 6 patients had an elevated level |
| UN – unmentioned; PD – pancreatoduodenectomy; CP – chronic pancreatitis. | |||||
| Study (study period) [Ref] | CA 19-9 | Imaging | Steroid trial | Preoperative biopsy | Concurrent malignancy |
| Detlefsen, 2012 (1987–2010) []20 | UN | UN | UN | UN | None |
| van Heerde, 2012 (2000–2009) []15 | (+) 3/7 (preoperational) | Non-typical | None | EUS-FNA performed in 1 patient | UN |
| Yurci, 2013 (1990–2012) []16 | Available in 30 patients, >150 IU/ml: 6 patients(20.0%) | Based on History classification, strongly signifying AIP: 10 patients, supportive of AIP: 6 patients, strongly signifying cancer: 7 patients | none before resection | 7 pts Cytology was negative in 6 cases and showed atypical ductal cells in 1 case | UN |
| Miura, 2013 (1990–2010) []14 | UN | Stenosis of the MPD: 10 patients (70%), Expansion of the MPD: 6 patients (46%), Pancreatic parenchymal expansion: Focal: 5 patients, Diffuse: 3 patients | UN | UN | None |
| Vitali, 2014 (2005–2011) []17 | UN | UN | UN | UN | None |
| Macinga, 2017 (2000–2013) []18 | Patients with AIP: 35.2 kU/L (median), patients with AIP + PC: 89.8 kU/L (median) | CT: Atypical imaging: 9 patients, Level 2 evidence based on ICDC: 6 patients | UN | EUS-FNA in 11 patients, AIP + PC: 3 positive, 1 inconclusive,AIP: 4 true negative, 2 false positive, 1 inconclusive | Type 1: 2 type 2: 4 |
| Dickerson, 2019 (1997–2016) []21 | (+) 12/26 | Stenosis of the MPD: 5 patients (20%), Expansion of the MPD: 3 patients (12%), Pancreatic parenchymal expansion: focal: 6 patients (24%), diffuse: 14 patients (56%), Tumor-like mass: 4 patients (16%), Double duct sign: 3 patients (12%) | UN | the EUS-FNA performed was negative for AIP | 3 patients |
| Seki, 2023 (1979–2018) []19 | UN | Abnormality at the MPD or/ and the common bile duct(n=9), incasement of the large vessels(n=4) | UN | EUS was performed for 3 patients, 1 diagnosed with TFCP | UN |
| Ikeura et al, 2014 []26 | UN | CT or MRI revealed focal enlargement of the pancreas in 19 patients (63%) and pancreatic mass in 11 patients (37%). Delayed enhancement of the lesion was observed in 6 of 9 patients who underwent dynamic CT or MRI. | 30% of the patients | UN | UN |
| Wojcicki et al, 2015 []27 | Available in 28 out of the 34 patients with levels >37 U/ml present only in 8 | Mass could be identified in 3 patients, biliary and pancreatic duct dilatation was present in 15 and 5 cases respectively and enlarged lymph nodes in 12. | UN | EUS-FNA samples have been obtained for 5 (4 – benign, 1- ‘atypical cells’). | UN |
| Kimura et al, 2014 []25 | 0 patients had an elevated level | UN | UN | 2 Pancreatic specimens taken by US-guided percutaneous needle biopsy, EUS-FNAC | UN |
| Zhang et al, 2015 (2003–2012) []23 | 9 patients had an elevated level | 11 exhibited diffuse pancreatic enlargement and focal pancreatic enlargement in the head of the pancreas, 4, ‘sausage-like’ pancreatic changes, 3, pancreatic duct expansion and 5, ‘halo’ sign pancreatic changes | UN | UN | UN |
| Clark et al, 2013 (1986–2011) []31 | UN | 24 Main pancreatic duct dilation8 Pancreatic cyst52 Focal mass14 Diffuse gland enlargement | UN | UN | UN |
| Ünalp et al, 2012 (2001–2010) []28 | 8 patients had an elevated level | UN | UN | UN | UN |
| Zhang et al, 2013 (1990–2010) []24 | UN | UN | UN | UN | UN |
| Nikolic et al, 2022 (2001–2020) []22 | 5 patients had an elevated level | UN | UN | UN | 2 patients |
| Vujasinovic et al, 2018 (2004–2018) []29 | UN | 54 focal pancreatic enlargement19 diffuse enlargement19 signs of acute pancreatitis | 100% of the patients | UN | UN |
| Tran et al, 2012 (2000–2010) []30 | 1 patient had an elevated level | 3 distal bile duct strictures5 pancreatic head masses2 dilated bile duct | 50% of the patients | 3 EUS-FNA1 major duodenal papilla core biopsy | UN |
| UN – unmentioned; PD – pancreatoduodenectomy; CP – chronic pancreatitis. | |||||