A 74-year-old male with lung squamous cell carcinoma who was treated with the anti PD-1 antibody nivolumab developed frequent diarrhea four months after initiating treatment. However, his condition did not improve despite prednisolone at 20mg. Endoscopic examination revealed loss of vascular pattern, erosions, and mucosal friability, resembling ulcerative colitis. Colonoscopy revealed punch-out ulcers in the affected mucosa. Therefore, he was definitively diagnosed with severe colitis caused by immune checkpoint inhibitor treatment and cytomegalovirus colitis. Nivolumab was discontinued, and he was treated with 60mg prednisolone and ganciclovir. Although his colitis improved, he developed pneumonia and died thereafter. This case highlights adverse events that are associated with immune checkpoint inhibitors which should be treated properly.
A 71-year-old female with non-dilated pancreaticobiliary maljunction (PBM) and gallbladder polypoid lesions underwent laparoscopic cholecystectomy. Histological examination of the polypoid lesions revealed gallbladder cancer. Five years after cholecystectomy, gradual dilatation of the main pancreatic duct (MPD) led to the identification of a papillary tumor growing in the MPD of the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Pathological examination revealed a papillary tumor with focal invasion to the MPD. Immunohistochemically, the tumor cells were positive for MUC1 and MUC5AC and negative for MUC2. Therefore, the definitive diagnosis was pancreatobiliary-type intraductal papillary mucinous carcinoma. This case emphasizes the significance of surveillance for potential cancer of the pancreas as well as the biliary tract in patients with PBM.
An 86-year-old male underwent pancreatoduodenectomy with resection and reconstruction of portal vein for pancreatic cancer. He was admitted to our hospital because of severe anemia and dyspnea ten months later. Computed tomography showed varices at the biliary-enteric anastomosis in the elevated jejunum caused by portal venous stenosis, which was suspected as the cause of anemia. Therefore, the patient underwent balloon dilatation of the portal vein followed by stent placement and coil embolization of the collaterals using a transileocolic portal vein approach. After the procedure, portal venous flow was improved, and the collaterals disappeared. The patient has been asymptomatic with no recurrence for three years and four months.
We herein report a rare case of autoimmune pancreatitis with small intestinal obstruction. A 72-year-old male was admitted to our hospital with abdominal fullness and vomiting and diagnosed with autoimmune pancreatitis by imaging and laboratory tests. Imaging studies also revealed narrowing of the proximal jejunum with dilated bowels and intramural cystic lesion adjacent to the pancreatic body. Small bowel resection was performed to alleviate stenosis. Pathological evaluation demonstrated invasion of IgG4-positive cells and fibrosis.