West Virginia University Charleston Division Charleston, WV, United States
Abdullah Sohail, MD1, Khadija Naseem, MD2, Adil Memon, MD2, Mujtaba Bhinder, MD2, Ahmad Khan, MD2, Hamza Shah, DO3 1West Virginia University Charleston Division, Charleston, WV; 2West Virginia University, Charleston Division, Charleston, WV; 3Charleston Gastroenterology, Charleston, WV
Introduction: Autoimmune pancreatitis is a rare autoimmune condition associated with pancreatic masses and ductal strictures. Although it has distinct clinical, histological, and morphological findings yet it closely resembles pancreatic malignancy. Therefore, the diagnosis of autoimmune pancreatitis can be a diagnostic challenge. We present a case of an 88-year-old male who presented with a pancreatic mass mimicking pancreatic carcinoma.
Case Description/Methods: An 88-year-old male presented to the hospital due to confusion and recurrent falls. He complained of severe lower back pain radiating to the right lower extremity. He had 50 pounds of unintentional weight loss in the last couple of months. He denied bowel or bladder incontinence and saddle anesthesia. The patient's vitals were stable. The exam was benign except for mild abdominal tenderness in the suprapubic region. The initial blood work was within normal limits. The patient urine analysis was positive for leukocyte esterase and nitrites. A computed tomography scan of the abdomen showed an incidental finding of a large pancreatic mass originating from the pancreatic body and extending to the pelvis (1A). The patient was admitted for a urinary tract infection and further workup of the abdominal mass. A positron emission tomography scan showed a hypermetabolic mass involving the proximal pancreatic body and extending to the presacral region (1B). The mass was highly suspicious for malignancy. The alpha-fetoprotein was 2.8 ng/ml, and carcinoembryonic antigen was 2.3 ng/ml. The patient's IgG4 antibodies were negative. He underwent esophagogastroduodenoscopy with endoscopic ultrasound for fine needle biopsy of the mass. The biopsies came back negative for malignant cells but showed atrophic pancreatic tissue with dense fibrosis and lymphoplasmacytic infiltrate (1C). The findings were suggestive of autoimmune pancreatitis and he was started on steroids. A follow-up ERCP and EUS were performed which showed interval resolution of the pancreatic mass.
Discussion: Autoimmune Pancreatitis (AP) is a form of chronic pancreatitis with presumed autoimmune etiology. The clinical and radiological presentation closely mimic pancreatic malignancy. Our patient with AP had an unusual presentation as a hypermetabolic pancreatic mass with a high suspicion of malignancy. The prompt diagnosis with appropriate treatment resulted in a favorable outcome. It is essential to differentiate AP from pancreatic malignancy to avoid unnecessary surgeries and procedures.
Figure: 1(A): CT scan showing pancreatic mass. 1(B): Pet Scan showing hypermetabolic pancreatic mass. 1(C): Pancreatic ducts with chronic inflammation and fibrosis
Disclosures: Abdullah Sohail indicated no relevant financial relationships. Khadija Naseem indicated no relevant financial relationships. Adil Memon indicated no relevant financial relationships. Mujtaba Bhinder indicated no relevant financial relationships. Ahmad Khan indicated no relevant financial relationships. Hamza Shah indicated no relevant financial relationships.
Abdullah Sohail, MD1, Khadija Naseem, MD2, Adil Memon, MD2, Mujtaba Bhinder, MD2, Ahmad Khan, MD2, Hamza Shah, DO3. P1156 - All That Pancreatic Masses Are Not Cancers!, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.