Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma: case report and review of the literature

Agnieszka K. Witkiewicz, Eugene P. Kennedy, Lawrence Kennyon, Charles J. Yeo, Ralph H. Hruban

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

An 80-year-old white man underwent pylorus-preserving pancreaticoduodenectomy after presenting with obstructive jaundice and a dilated biliary tree on cholangiopancreatography. Histologic evaluation of the specimen revealed synchronous autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) and infiltrating ductal adenocarcinoma of the pancreas. The mixed inflammatory infiltrate centered on the pancreatic ducts was associated with acinar loss, parenchymal fibrosis, and obliterative venulitis. Immunohistochemical labeling with an antibody to IgG4 revealed greater than 50 IgG4-positive plasma cells per high power field. Although not appreciated grossly, pancreatic intraepithelial neoplasia-3 and a neurotropic infiltrating poorly differentiated adenocarcinoma of the pancreas were also present. This case highlights the importance of carefully evaluating patients with autoimmune pancreatitis to rule out an underlying neoplasm and the importance of following those who were treated nonsurgically until the disease fully resolves. Crown

Original languageEnglish (US)
Pages (from-to)1548-1551
Number of pages4
JournalHuman Pathology
Volume39
Issue number10
DOIs
StatePublished - Oct 2008

Fingerprint

Pancreatitis
Adenocarcinoma
Pancreas
Immunoglobulin G
Pancreaticoduodenectomy
Obstructive Jaundice
Pancreatic Ducts
Pylorus
Biliary Tract
Plasma Cells
Crowns
Neoplasms
Fibrosis
Antibodies

Keywords

  • Autoimmune pancreatitis
  • Lymphoplasmacytic sclerosing pancreatitis
  • Pancreatic adenocarcinoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma : case report and review of the literature. / Witkiewicz, Agnieszka K.; Kennedy, Eugene P.; Kennyon, Lawrence; Yeo, Charles J.; Hruban, Ralph H.

In: Human Pathology, Vol. 39, No. 10, 10.2008, p. 1548-1551.

Research output: Contribution to journalArticle

Witkiewicz, Agnieszka K. ; Kennedy, Eugene P. ; Kennyon, Lawrence ; Yeo, Charles J. ; Hruban, Ralph H. / Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma : case report and review of the literature. In: Human Pathology. 2008 ; Vol. 39, No. 10. pp. 1548-1551.
@article{0086ea9671634481a61f353cab83777f,
title = "Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma: case report and review of the literature",
abstract = "An 80-year-old white man underwent pylorus-preserving pancreaticoduodenectomy after presenting with obstructive jaundice and a dilated biliary tree on cholangiopancreatography. Histologic evaluation of the specimen revealed synchronous autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) and infiltrating ductal adenocarcinoma of the pancreas. The mixed inflammatory infiltrate centered on the pancreatic ducts was associated with acinar loss, parenchymal fibrosis, and obliterative venulitis. Immunohistochemical labeling with an antibody to IgG4 revealed greater than 50 IgG4-positive plasma cells per high power field. Although not appreciated grossly, pancreatic intraepithelial neoplasia-3 and a neurotropic infiltrating poorly differentiated adenocarcinoma of the pancreas were also present. This case highlights the importance of carefully evaluating patients with autoimmune pancreatitis to rule out an underlying neoplasm and the importance of following those who were treated nonsurgically until the disease fully resolves. Crown",
keywords = "Autoimmune pancreatitis, Lymphoplasmacytic sclerosing pancreatitis, Pancreatic adenocarcinoma",
author = "Witkiewicz, {Agnieszka K.} and Kennedy, {Eugene P.} and Lawrence Kennyon and Yeo, {Charles J.} and Hruban, {Ralph H.}",
year = "2008",
month = "10",
doi = "10.1016/j.humpath.2008.01.021",
language = "English (US)",
volume = "39",
pages = "1548--1551",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",
number = "10",

}

TY - JOUR

T1 - Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma

T2 - case report and review of the literature

AU - Witkiewicz, Agnieszka K.

AU - Kennedy, Eugene P.

AU - Kennyon, Lawrence

AU - Yeo, Charles J.

AU - Hruban, Ralph H.

PY - 2008/10

Y1 - 2008/10

N2 - An 80-year-old white man underwent pylorus-preserving pancreaticoduodenectomy after presenting with obstructive jaundice and a dilated biliary tree on cholangiopancreatography. Histologic evaluation of the specimen revealed synchronous autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) and infiltrating ductal adenocarcinoma of the pancreas. The mixed inflammatory infiltrate centered on the pancreatic ducts was associated with acinar loss, parenchymal fibrosis, and obliterative venulitis. Immunohistochemical labeling with an antibody to IgG4 revealed greater than 50 IgG4-positive plasma cells per high power field. Although not appreciated grossly, pancreatic intraepithelial neoplasia-3 and a neurotropic infiltrating poorly differentiated adenocarcinoma of the pancreas were also present. This case highlights the importance of carefully evaluating patients with autoimmune pancreatitis to rule out an underlying neoplasm and the importance of following those who were treated nonsurgically until the disease fully resolves. Crown

AB - An 80-year-old white man underwent pylorus-preserving pancreaticoduodenectomy after presenting with obstructive jaundice and a dilated biliary tree on cholangiopancreatography. Histologic evaluation of the specimen revealed synchronous autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) and infiltrating ductal adenocarcinoma of the pancreas. The mixed inflammatory infiltrate centered on the pancreatic ducts was associated with acinar loss, parenchymal fibrosis, and obliterative venulitis. Immunohistochemical labeling with an antibody to IgG4 revealed greater than 50 IgG4-positive plasma cells per high power field. Although not appreciated grossly, pancreatic intraepithelial neoplasia-3 and a neurotropic infiltrating poorly differentiated adenocarcinoma of the pancreas were also present. This case highlights the importance of carefully evaluating patients with autoimmune pancreatitis to rule out an underlying neoplasm and the importance of following those who were treated nonsurgically until the disease fully resolves. Crown

KW - Autoimmune pancreatitis

KW - Lymphoplasmacytic sclerosing pancreatitis

KW - Pancreatic adenocarcinoma

UR - http://www.scopus.com/inward/record.url?scp=50649110033&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=50649110033&partnerID=8YFLogxK

U2 - 10.1016/j.humpath.2008.01.021

DO - 10.1016/j.humpath.2008.01.021

M3 - Article

C2 - 18619645

AN - SCOPUS:50649110033

VL - 39

SP - 1548

EP - 1551

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

IS - 10

ER -