Table of Contents    
Case Report
 
The quandary of autoimmune pancreatitis and pancreatic ductal adenocarcinoma: A case report and review of IgG4 immunostaining in a cohort of patients receiving neoadjuvant chemotherapy
Ornela Dervishaj1, Harish Lavu1, Charles J Yeo1, Agnieszka K Witkiewicz2
1Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary & Related Cancer Center, Philadelphia PA, USA.
2Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA.

Article ID: 100010IJHPDOD2013
doi:10.5348/ijhpd-2013-10-CR-1

Address correspondence to:
Agnieszka K Witkiewicz
MD, 132 S. 10th Street
Suite 285 D Philadelphia
PA 19107
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Phone: (215) 955-3778
Fax: (215) 955-5058
Email: agnieszka.witkiewicz@jefferson.edu

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How to cite this article:
Dervishaj O, Lavu H, Yeo CJ, Witkiewiez AK. The quandary of autoimmune pancreatitis and pancreatic ductal adenocarcinoma: A case report and review of IgG4 immunostaining in a cohort of patients receiving neoadjuvant chemotherapy. International Journal of Hepatobiliary and Pancreatic Diseases 2013;3:1–9.


Abstract
Introduction: Autoimmune pancreatitis (AIP) is an inflammatory disease whose clinical presentation can mimic that of pancreatic ductal adenocarcinoma (PDA). AIP can appear on imaging as a bulky, sausage-like pancreatic mass with biliary and pancreatic ductal obstruction, resembling the classic "double duct sign" appearance of PDA. A definitive preoperative diagnosis of AIP can be difficult because the two diseases (AIP and PDA) are similar in clinical presentation. Recent advances in serum marker evaluation such as IgG4 serum levels and immunostaining techniques have shown some promise in the differentiation of AIP from PDA.
Case Report: We report the case of a patient with a preoperative diagnosis of locally advanced PDA who was treated with neoadjuvant gemcitabine based chemotherapy followed by surgical resection, but whose post-resection pathology was indicative of AIP and not PDA. To explore the possibility that the pre-resection gemcitabine-based chemotherapy had generated a complete pathological response and an inflammatory reaction of IgG4-positive plasma cells, we studied the histology features and IgG4 plasma cell immunostaining characteristics of the pathology specimens of 14 patients with a diagnosis of PDA who were treated with neoadjuvant chemotherapy and surgical resection at our institution.
Conclusion: Our results indicate that none of the patients treated with neoadjuvant chemotherapy had increased IgG4-positive plasma cell immunostaining post-operatively, further supporting the diagnosis of AIP and not PDA in our patient.

Key Words: Autoimmune pancreatitis, Pancreatic tumor, Adenocarcinoma

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Author Contributions:
Ornela Dervishaj - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Harish Lavu - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Charles J Yeo - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Agnieszka K Witkiewicz - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
Authors declare no conflict of interest.
Copyright:
© Ornela Dervishaj et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)