Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2019; 11(12): 443-448
Published online Dec 27, 2019. doi: 10.4240/wjgs.v11.i12.443
Early pancreatic cancer in IgG4-related pancreatic mass: A case report
Juan Glinka, Francisco Calderón, Martín de Santibañes, Sung Ho Hyon, Adrián Gadano, Eduardo Mullen, Melina Pol, Juan Spina, Eduardo de Santibañes
Juan Glinka, Francisco Calderón, Martín de Santibañes, Eduardo de Santibañes, Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
Sung Ho Hyon, Department of General Surgery, Image Guided Minimally Invasive Surgery Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
Adrián Gadano, Hepatology Section, Hospital Italiano Buenos Aires, Buenos Aires C1181ACH, Argentina
Eduardo Mullen, Melina Pol, Department of Surgical Pathology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
Juan Spina, Department of Radiology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
Author contributions: Glinka J and Calderón F designed the report; Calderón F collected the patient’s clinical data; Spina J, Mullen E and Pol M provided relevant figures; Glinka J, Calderón F, Hyon SH, Gadano A, de Santibañes M and de Santibañes E analyzed the data and wrote the paper.
Informed consent statement: Consent was obtained from the patient for publication.
Conflict-of-interest statement: The authors declare that no conflict of interest exists.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Juan Glinka, MD, Attending Doctor, Surgeon, Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, Buenos Aires C1181ACH, Argentina. juan.glinka@hospitalitaliano.org.ar
Telephone: +54-11-49814501
Received: August 23, 2019
Peer-review started: August 23, 2019
First decision: September 13, 2019
Revised: September 18, 2019
Accepted: November 7, 2019
Article in press: November 7, 2019
Published online: December 27, 2019
Abstract
BACKGROUND

IgG4-related disease can manifest diversely, including autoimmune pancreatitis and IgG4-related cholangiopathy. We are reporting a very unusual cause of pancreatic cancer triggered in a previously unknown IgG4-related disease.

CASE SUMMARY

A 75-year-old man was diagnosed with a 43 mm × 33 mm pancreatic head tumor after consulting for abdominal pain and jaundice. A pancreaticoduodenectomy was carried out uneventfully, and the histopathology report showed an early stage of acinar-cell pancreatic cancer. The patient reconsulted on the 30th postoperative day with fever, jaundice and asthenia. Magnetic resonance cholangiopancreatography evidenced an extense bile duct stricture. A percutaneous biliary drainage proved to be ineffective, even after exchanging it with larger bore drainage. Reviewing the surgical specimen, features compatible with IgG4-related disease were observed. Consequently, empiric treatment with steroids was initiated achieving excellent results.

CONCLUSION

IgG4-related disease may cause chronic inflammation of the pancreas and can condition pancreatic malignancies.

Keywords: Autoimmune pancreatitis, Pancreatic adenocarcinoma, Pancreatic cancer, IgG4, IgG4-related disease, Case report

Core tip: Until today, the relationship between autoimmune pancreatitis and pancreatic cancer was not clear, and there are no studies in this regard. We are reporting a very unusual cause of pancreatic cancer triggered in a previously unknown IgG4-related disease and conducted an up-to-date literature review.