Abstract
We have encountered an example of a case of autoimmune pancreatitis (AIP) accompanied by lower bile duct contraction in a male patient who was operated on the basis of cytological and radiological findings. Here we report bibliographic considerations in relation to this case. A 54-year-old male with jaundice was introduced to our hospital by a general practitioner. In a blood test, the bilirubin and biliary enzyme levels were high. Since the extension of the internal and external bile duct of the liver was detected by CT, he was diagnosed as having obstructive jaundice and hospitalized for detailed examination and medical treatment. High levels of the tumor markers CEA and CA19-9 were observed in a blood test at the time of hospitalization. Magnetic resonance cholangiopancreatography and ultrasonography were performed, which revealed a lower bile duct tumor and he was diagnosed as having obstructive jaundice. A cytological examination of the bile, led to a suspicion of malignancy and the head of the pancreas duodenum was excised. A cytological diagnosis of the excised duodenum revealed a mammillary cluster, which overlapped with the suspicion of neoplastic lesion. Macroscopic analysis showed no tuberosity lesion in the pancreas, but the histopathological diagnosis was lymphoplasmacytic sclerosing pancreatitis (LPSP) and cholangitis. Blood plasma cell analysis revealed IgG4 positivity in about 50 cells in the high power field. He was diagnosed as having AIP accompanied by IgG4-related sclerosing cholangitis (IgG4-SC). AIP is an inflammatory disorder for which steroids are effective. At present, It is not clear whether it becomes a risk factor for development of malignant tumor symptoms or whether an operation is necessary or not. There is also no standardization of cytological characteristics and it is necessary to collect cases from now on and to explore the feature of the cell that appears in bile.
