PMC9876015_01
Computed tomography of the abdomen and pelvis revealed (indicated by circle) distended pancreatic parenchyma with peripancreatic stranding with segments of biliary ductal dilation.
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F1
A repeat CT scan demonstrated distended pancreatic parenchyma with peripancreatic stranding with segments of biliary ductal dilation (Figure 1).
First ERCP with length of stricture marked between the 2 arrows. ERCP, endoscopic retrograde cholangiopancreatography.
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F2
On endoscopic retrograde cholangiopancreatography (ERCP), the lower third of the main bile duct contained a single severe stenosis 20-25 mm in length and a biliary stent was placed (Figure 2).
Hypoechoic gland with hyperechoic foci without shadowing.
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F3
Endoscopic ultrasound was performed and pancreatic parenchyma was diffusely abnormal with lobularity, generalized hypoechoic gland, and hyperechoic foci without shadowing (Figure 3).
(A) Low-power (x4) hematoxylin and eosin (H&E) stained slide of immunoglobulin G4 (IgG4)-related chronic pancreatitis. Histopathological image of pancreatic parenchyma with dense storiform fibrosis and lymphoplasmacytic infiltrate. (B) High-power (x40) H&E stained slide of IgG4-related chronic pancreatitis. Histopathological image of pancreatic parenchyma with duct centric lymphoplasmacytic infiltrate.
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F4
Fine needle biopsies were obtained from the pancreatic body (Figures 4).
(A) Medium-power (x10) immunohistochemical positivity for IgG on plasma cells. (B) High-power (x40) immunohistochemical positivity for IgG4 on plasma cells.
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F5
Immunohistochemical tests showed IgG and IgG4 positive plasma cells (Figures 5).
Repeat ERCP with much improved stricture. ERCP, endoscopic retrograde cholangiopancreatography.
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F6
Repeat ERCP showed improvement of the lower third of the main bile duct with a focal area of stenosis at 8 mm in length (Figure 6).