PMC4586910_01
A 58-year-old female with multifocal autoimmune pancreatitis. The pancreas appears grossly enlarged.. (A) Axial contrast-enhanced CT (venous phase) shows poorly enhancing focal lesions in the pancreatic head (arrow) and (B) tail (arrow). (C) Coronal contrast-enhanced CT shows intrahepatic cholestasis by stenosis of the bile duct. (D) CT curved reconstruction along the pancreatic duct shows both lesions, interruption and dilatation of the intrapancreatic tract.
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On intravenously contrast enhanced CT the pancreas showed a focally well-defined, hypoenhancing mass in the pancreatic head and a diffusely swollen, hypoenhancing tail with ill-defined outlines due to stranding of the surrounding fatty tissue (Figure 1A and B). Intrahepatic cholestasis by stenosis of the bile duct was present (Figure 1C); however, the pancreatic main duct was not enlarged on CT. Locoregional lymphadenopathy was present (Figure 1A and B).
A 58-year-old female with multifocal autoimmune pancreatitis. The pancreas appears overall to be edematously swollen.. (A) Axial T1-weighted MRI (LAVA) shows focal lesions in the pancreatic head (arrow) and (B) tail (arrow). (C, D) Corresponding axial contrast-enhanced T1-weighted MRI during arterial phase, (E, F) during portal venous phase, and (G, H) axial fat-saturated T2-weighted MRI during venous phase. (I) MRCP shows dilation and interruption of the pancreatic duct (arrow).
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On native, fat-saturated, T1-weighted images (LAVA), the 2 solid lesions presented hypo- to iso-intensely (Figure 2A and B) as on native, fat-saturated, T2-weighted images (Figure 2G and H). Also on contrast-enhanced series the lesions presented hypo- to iso-intensely during arterial (Figure 2C and D) and portal venous phase (Figure 2E and F). The MRCP showed stenosis of the bile duct (DHC), intrahepatic cholestasis, and hence dilatation of the DHC as well as dilatation and interruption of the pancreatic duct (Figure 2I).
A 58-year-old female with multifocal autoimmune pancreatitis. Histopathologic evaluation shows dense inflammatory infiltrations composed of plasma cells and lymphocytes.. (A) Large pancreatic ducts, bile ducts, and (B) intra- and extrapancreatic veins and nerves in the focus of inflammation. (C) Immunohistochemistry for IgG4 revealed an elevated concentration of IgG4-positive plasma cells.
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Large pancreatic ducts, bile ducts (Figure 3A), as well as intra- and extrapancreatic veins (Figure 3B) and nerves were in the focus of inflammation. Immunohistochemistry for IgG4 (Figure 3C) revealed an elevated concentration of IgG4-positive plasma cells.