Pancreatic cancer with a high serum IgG4 concentration

Differentiation between autoimmune pancreatitis and pancreatic cancer is sometimes difficult. It has been reported that serum IgG4 concentrations are significantly elevated and particularly high (>135 mg/dL) in autoimmune pancreatitis. Measurement of serum IgG4 has become a useful tool for differentiating between autoimmune pancreatitis and pancreatic cancer. However, we present a 74-year-old female with a markedly elevated serum IgG4 (433 mg/dL) who underwent pancreaticoduodenectomy for pancreatic cancer. Elevated serum IgG4 levels continued after the resection. On histology, adenocarcinoma of the pancreas accompanied with moderate lymphoplasmacytic infiltration infiltrated the lower bile duct and duodenum, but there were no findings of autoimmune pancreatitis. Although a small metastasis was detected in one parapancreatic lymph node, regional lymph nodes were swollen. Abundant IgG4-positive plasma cells infiltrated the cancerous areas of the pancreas, but only a few IgG4-positive plasma cells were detected in the noncancerous areas. Pancreatic cancer cells were not immunoreactive for IgG4. An abundant infiltration of IgG4-positive plasma cells was detected in the swollen regional lymph nodes and in the duodenal mucosa. We believe that the serum IgG4 level was elevated in this patient with pancreatic cancer as the result of an IgG4-related systemic disease that had no clinical manifestations other than lymphadenopathy.

Autoimmune pancreatitis metachronously associated with retroperitoneal fibrosis with IgG4-positive plasma cell infiltration

腹膜后纤维变性是纤维组织的稠密的匾的形成在制动火箭腹膜描绘的不平常的混乱，并且它的病原学仍然保持未知。自体免疫的胰腺炎是纤维变性在胰与 IgG4 积极的血浆房间和淋巴细胞和 obliterative 静脉炎的丰富的渗入描绘的慢性胰炎的一种稀罕类型。我们在场在制动火箭的出现以后开发了 10 瞬间的自体免疫的胰腺炎的一个盒子腹纤维变性。resected 制动火箭腹团的组织检查所见是有 IgG4 积极的血浆房间和淋巴细胞和 obliterative 静脉炎的丰富的渗入的显著 periureteral 纤维变性。这些调查结果在这种情况中为制动火箭腹纤维变性和自体免疫的胰腺炎建议普通 pathophysiological 机制。制动火箭腹纤维变性力量的一些盒子是 IgG4 相关的致硬化的疾病的制动火箭腹损害。