PDF(Pubmed)
Abstract：
UNASSIGNED: Autoimmune pancreatitis (AIP) is recognized as a disease with a good prognosis that responds well to steroids, but the complication of pancreatic ductal adenocarcinoma (PDAC) in AIP is a rare condition. We report a case of PDAC encapsulated by tumor-forming type 1 AIP.
UNASSIGNED: The patient, a 65-year-old female, was found to have high CA19-9 levels and a pancreatic mass with a diameter of 30 mm on abdominal ultrasonography. Contrast-enhanced computed tomography revealed a 40-mm mass in the tail of the pancreas that had a 27-mm oligemic mass inside it. From these work-up examinations, this tumor was diagnosed as PDAC, with evidence of colonic invasion. As curative resection for PDAC, a distal pancreatectomy with splenectomy and combined colon resection were performed. Histopathological examination showed invasive PDAC surrounded by IgG4-positive plasma cell infiltration. Based on these findings, a diagnosis was made of PDAC located in the pancreatic tail capsulized by type 1 AIP. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. She underwent postoperative adjuvant chemotherapy with S-1 for 6 months, and no recurrence was noted for 2 years after operation.
UNASSIGNED: Currently, there are two hypothetical mechanisms of PDAC induction by AIP: (1) carcinogenic stimulation due to chronic inflammation and (2) paraneoplastic syndrome caused by AIP. Further study of the relationship between AIP and pancreatic cancer is needed, and follow-up should be conducted while keeping in mind the possibility of complications.
UNASSIGNED: The patient, a 65-year-old female, was found to have high CA19-9 levels and a pancreatic mass with a diameter of 30 mm on abdominal ultrasonography. Contrast-enhanced computed tomography revealed a 40-mm mass in the tail of the pancreas that had a 27-mm oligemic mass inside it. From these work-up examinations, this tumor was diagnosed as PDAC, with evidence of colonic invasion. As curative resection for PDAC, a distal pancreatectomy with splenectomy and combined colon resection were performed. Histopathological examination showed invasive PDAC surrounded by IgG4-positive plasma cell infiltration. Based on these findings, a diagnosis was made of PDAC located in the pancreatic tail capsulized by type 1 AIP. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. She underwent postoperative adjuvant chemotherapy with S-1 for 6 months, and no recurrence was noted for 2 years after operation.
UNASSIGNED: Currently, there are two hypothetical mechanisms of PDAC induction by AIP: (1) carcinogenic stimulation due to chronic inflammation and (2) paraneoplastic syndrome caused by AIP. Further study of the relationship between AIP and pancreatic cancer is needed, and follow-up should be conducted while keeping in mind the possibility of complications.
摘要：
■自身免疫性胰腺炎（AIP）被认为是一种预后良好的疾病，对类固醇反应良好，但胰腺导管腺癌（PDAC）在AIP中的并发症是一种罕见的疾病。我们报告了一例被形成肿瘤的1型AIP包裹的PDAC。
■病人,一位65岁的女性,在腹部超声检查中发现CA19-9水平高，胰腺肿块直径为30mm。对比增强的计算机断层扫描显示，胰腺尾部有40毫米的肿块，内部有27毫米的寡肿块。从这些体检中，这个肿瘤被诊断为PDAC，有结肠侵入的证据.作为PDAC的治愈性切除，进行了远端胰腺切除术，脾切除术和联合结肠切除术。组织病理学检查显示侵袭性PDAC被IgG4阳性浆细胞浸润包围。基于这些发现,诊断为位于胰尾的PDAC被1型AIP包裹。术后进展顺利，患者在术后第15天出院。术后给予S-1辅助化疗6个月,术后2年无复发。
■目前，AIP诱导PDAC的机制有两种：（1）慢性炎症引起的致癌刺激和（2）AIP引起的副肿瘤综合征。需要进一步研究AIP与胰腺癌之间的关系，应进行随访，同时注意并发症的可能性。
■病人,一位65岁的女性,在腹部超声检查中发现CA19-9水平高，胰腺肿块直径为30mm。对比增强的计算机断层扫描显示，胰腺尾部有40毫米的肿块，内部有27毫米的寡肿块。从这些体检中，这个肿瘤被诊断为PDAC，有结肠侵入的证据.作为PDAC的治愈性切除，进行了远端胰腺切除术，脾切除术和联合结肠切除术。组织病理学检查显示侵袭性PDAC被IgG4阳性浆细胞浸润包围。基于这些发现,诊断为位于胰尾的PDAC被1型AIP包裹。术后进展顺利，患者在术后第15天出院。术后给予S-1辅助化疗6个月,术后2年无复发。
■目前，AIP诱导PDAC的机制有两种：（1）慢性炎症引起的致癌刺激和（2）AIP引起的副肿瘤综合征。需要进一步研究AIP与胰腺癌之间的关系，应进行随访，同时注意并发症的可能性。
