Abstract
A 75-year-old Japanese woman visited a hospital with a stomachache. The patient was diagnosed with localized mild acute pancreatitis. Blood tests revealed elevated serum IgG4 levels. Contrast-enhanced computed tomography showed a hypovascular mass, 3 cm in size, in the pancreatic body with dilation of the upstream duct. Additionally, it showed another tumorous lesion of 10 mm in size in the anterior wall of the stomach, and endoscopic examination confirmed a submucosal tumor (SMT) sized 10 mm in the anterior wall of the stomach. Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) of the pancreas revealed an adenocarcinoma concomitant with marked IgG4-positive cell infiltration. Hence, distal pancreatectomy with local gastrectomy was performed, and the final diagnosis was concluded as pancreatic ductal adenocarcinoma (PDAC) complicated by IgG4-related diseases (IgG4-RD) in the pancreas and stomach. IgG4-RD of the digestive tract is exceedingly rare. The correlation between PDAC and autoimmune pancreatitis or malignancy and IgG4-RD is controversial. However, the clinical course and histopathological examination, in this case, provide valuable suggestive findings for further discussion.
Similar content being viewed by others
References
Kamisawa T, Zen Y, Pillai S, et al. IgG4-related disease. Lancet. 2015;385:1460–71.
Takano Y, Nagahama M, Yamamura E, et al. A case of concurrent pancreatic intraepithelial neoplasia and type 1 autoimmune pancreatitis with marked pancreatic duct dilatation. Clin J Gastroenterol. 2016;9:266–71.
Sugiyama T, Tajiri T, Hiraiwa S, et al. A case of high-grade pancreatic intraepithelial neoplasia concomitant with type 1 autoimmune pancreatitis: the process underlying both conditions. Pathol Int. 2019;69:165–71.
Ikeura T, Miyoshi H, Uchida K, et al. Relationship between autoimmune pancreatitis and pancreatic cancer: a single-center experience. Pancreatology. 2014;14:373–9.
Gupta R, Khosroshahi A, Shinagare S, et al. Does autoimmune pancreatitis increase the risk of pancreatic carcinoma?: a retrospective analysis of pancreatic resections. Pancreas. 2013;42:506–10.
Sumimoto K, Uchida K, Ikeura T, et al. Nationwide epidemiological survey of immunoglobulin G4-related disease with malignancy in Japan. J Gastroenterol Hepatol. 2022;37:1022–33.
Tang H, Yang H, Zhang P, et al. Malignancy and IgG4-related disease: the incidence, related factors and prognosis from a prospective cohort study in China. Sci Rep. 2020;10:4910.
Yu T, Wu Y, Liu J, et al. The risk of malignancy in patients with IgG4-related disease: a systematic review and meta-analysis. Arthritis Res Ther. 2022;24:14.
Hirano K, Tada M, Sasahira N, et al. Incidence of malignancies in patients with IgG4-related disease. Intern Med. 2014;53:171–6.
Denk D, Greten FR. Inflammation: the incubator of the tumor microenvironment. Trends Cancer. 2022;8:901–14.
Kong X, Sun T, Kong F, et al. Chronic pancreatitis and pancreatic cancer. Gastrointest Tumors. 2014;1:123–34.
Shiokawa M, Kodama Y, Yoshimura K, et al. Risk of cancer in patients with autoimmune pancreatitis. Am J Gastroenterol. 2013;108:610–7.
Shiokawa M, Kodama Y, Sekiguchi K, et al. Laminin 511 is a target antigen in autoimmune pancreatitis. Sci Transl Med. 2018;10:eaaq0997.
Löhr JM, Vujasinovic M, Rosendahl J, et al. IgG4-related diseases of the digestive tract. Nat Rev Gastroenterol Hepatol. 2022;19:185–97.
Backhus J, Seufferlein T, Perkhofer L, et al. IgG4-related diseases in the gastrointestinal tract: clinical presentation, diagnosis and treatment challenges. Digestion. 2019;100:1–14.
Notohara K, Kamisawa T, Uchida K, et al. Gastrointestinal manifestation of immunoglobulin G4-related disease: clarification through a multicenter survey. J Gastroenterol. 2018;53:845–53.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gonda, M., Kobayashi, T., Notohara, K. et al. A case of pancreatic ductal adenocarcinoma concomitant with IgG4-related disease in the pancreas and the stomach. Clin J Gastroenterol 16, 785–790 (2023). https://doi.org/10.1007/s12328-023-01814-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-023-01814-w