Autoimmune pancreatitis and hepatic inflammatory pseudotumors associated with IgG4-related sclerosing cholangitis

Abstract

A 66-year-old man was found to have an elevated liver enzyme level and a tumor in the liver by his family doctor and was admitted to our hospital for treatment. A tumor in the liver in Segment 7 and a tumor in the tail of the pancreas were identified at preoperative examinations. Imaging diagnosis was very difficult. Therefore, he underwent surgery for diagnosis and curative treatment. Intraoperative US revealed multiple tumors in the liver. For the purpose of confirming the diagnosis of the tumor in the tail of the pancreas, spleen preserving distal pancreatectomy was performed. Intraoperative specimen of the tail of the pancreas showed inflammatory pseudotumor (IPT). Intraoperative biopsy specimen of the liver showed IPT. Both tumors were histopathologically diagnosed as IgG4-related disease (IgG4-RD). In the case of pancreatic or hepatic tumors with elevated levels of serum IgG4, biopsy or endoscopic ultrasound-guided fine needle aspiration could be considered owing to the possibility of IgG4-RD.