IgG4-related disease mimicking pancreatic cancer: Case report and review of the literature
| Autor: | Lajos Szabados, Ibnouf Sulieman, Ahmed Mahfouz, Einas Alkuwari, A. Elaffandi, Walid Elmoghazy, Hatem Khalaf |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
FNAC
fine needle aspiration cytology Pathology medicine.medical_specialty IgG4 immunoglobulin-G4 related disease IgG immunoglobulin G AST aspartate aminotransferase Pancreas lesions Article 03 medical and health sciences 0302 clinical medicine AIP autoimmune pancreatitis IgG4 related disease Fibrosis Pancreatic cancer ALT alanine aminotransferase Biopsy parasitic diseases Case report medicine BPH benign prostatic hyperplasia Lymph node Autoimmune pancreatitis 030203 arthritis & rheumatology Submandibular lymph nodes medicine.diagnostic_test AFP alfa feto protein business.industry GFR glomerular filtration rate medicine.disease medicine.anatomical_structure HBV hepatitis B virus 030220 oncology & carcinogenesis HCV hepatitis C virus Surgery IgG4-related disease CEA carcinoembryonic antigen Pancreas business FDG-PET fluorodeoxyglucose positron emission tomography MRI magnetic resonance imaging MRCP magnetic resonance cholangio-pancreatography EUS endoscopic ultrasound |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Pancreatic masses pose a diagnostic challenge, and cancer has to be always considered. • IgG4-related disease is a rare cause of pancreatic masses. • Biopsy from the pancreas is not always required if histopathology from a more accessible peripheral site lesion confirms the diagnosis. • Multiorgan involvement and aortitis should raise suspicion of IgG4-related disease. Introduction Most patients with pancreatic masses pose a diagnostic challenge when a benign lesion is suspected, and often, resection is needed before a benign diagnosis is confirmed. Presentation of case A 57 years old male patient presented with a pancreatic head mass, obstructive jaundice and submandibular lymph node enlargement. He also had a history of recurrent eye pain and redness, skin lesions, and benign prostatic hypertrophy. MRI showed a pancreatic head mass with double duct sign, aortic thickening, bilateral renal lesions, diffuse lymph node enlargement, and prostatic enlargement. FDG-PET/CT demonstrated abnormal uptake corresponding to the MRI lesions, and there were elevated IgG4 levels on blood investigations. Biopsy of an inguinal lymph node revealed infiltrates with IgG4 plasma cells, consistent with the diagnosis of IgG4 disease. The patient was treated with IV steroids and showed significant improvement. Discussion IgG4 related disease is a rare entity that is characterized by lesions that show heavy infiltration with IgG4 positive plasma cells, storiform fibrosis, and obliterative phlebitis. The pancreas is the most commonly involved organ, but several other organ systems are involved, and this helps in clinical suspicion of the diagnosis. A biopsy from any easily accessible site that shows the characteristic histological features is sufficient for diagnosis. Patients respond quickly to steroids, but recurrence is frequent. Conclusion IgG4 related disease is a rare cause of pancreatic tumorous lesions that need a high index of suspicion for diagnosis and should be differentiated from pancreatic neoplastic lesions. |
| Databáze: | OpenAIRE |
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