History: 58 yo woman with weight loss and jaundice.
Solution: Autoimmune pancreatitis
These images show fairly characteristic findings of autoimmune pancreatitis, which include diffuse enlargement of the gland with associated effacement of the normal pancreatic lobulations and a subtle peripancreatic halo. As seen in this case, the involvement can be both diffuse and focal and when it involves the head of the pancreas, it can result in biliary ductal stenosis and associated jaundice and biliary obstructive symptoms. As in this case, the ductal stenosis is often smooth and tapering, more typical of a benign stricture than a malignant stricture, but the distinction can be difficult. There is no discrete mass in this case and the involvement of the gland is diffuse, both of which argue against pancreatic cancer.
Autoimmune pancreatitis is a benign condition that is often misdiagnosed as pancreatic cancer. This condition is also known by a number of other names, including lymphoplasmacytic sclerosing pancreatitis, , primary inflammatory pancreatitis, sclerosing pancreatitis, nonalcoholic duct destructive chronic pancreatitis, primary chronic pancreatitis, and idiopathic tumefactive chronic pancreatitis. It occurs more commonly in men and the median age of presentation is around 60 (range 30-80).
The condition is due to an inflammatory injury of the pancreas due to an autoimmune mediated process and can be associated with other autoimmune diseases.
Patients who have autoimmune pancreatitis can present with a variety of mostly non-specific symptoms including abdominal pain, weight loss, and jaundice.
Specific diagnosis requires fine needle aspiration, which can be performed with endoscopic US or percutaneously.
Treatment of autoimmune pancreatitis is corticosteroids and the prognosis is generally good, although there is little long term data since it has only recently been recognized as a distinct entity.
These images show fairly characteristic findings of autoimmune pancreatitis, which include diffuse enlargement of the gland with associated effacement of the normal pancreatic lobulations and a subtle peripancreatic halo. As seen in this case, the involvement can be both diffuse and focal and when it involves the head of the pancreas, it can result in biliary ductal stenosis and associated jaundice and biliary obstructive symptoms. As in this case, the ductal stenosis is often smooth and tapering, more typical of a benign stricture than a malignant stricture, but the distinction can be difficult. There is no discrete mass in this case and the involvement of the gland is diffuse, both of which argue against pancreatic cancer.
Autoimmune pancreatitis is a benign condition that is often misdiagnosed as pancreatic cancer. This condition is also known by a number of other names, including lymphoplasmacytic sclerosing pancreatitis, , primary inflammatory pancreatitis, sclerosing pancreatitis, nonalcoholic duct destructive chronic pancreatitis, primary chronic pancreatitis, and idiopathic tumefactive chronic pancreatitis. It occurs more commonly in men and the median age of presentation is around 60 (range 30-80).
The condition is due to an inflammatory injury of the pancreas due to an autoimmune mediated process and can be associated with other autoimmune diseases.
Patients who have autoimmune pancreatitis can present with a variety of mostly non-specific symptoms including abdominal pain, weight loss, and jaundice.
Specific diagnosis requires fine needle aspiration, which can be performed with endoscopic US or percutaneously.
Treatment of autoimmune pancreatitis is corticosteroids and the prognosis is generally good, although there is little long term data since it has only recently been recognized as a distinct entity.
Radiograph Images
