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Presented by Ralph Hruban, M.D. and prepared by Alex Chang, M.D.
Case 6: This patient developed abdominal pain and slight jaundice.
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Week 411: Case 6
This patient developed abdominal pain and slight jaundice. Imaging revealed an ill-defined fullness in the head of the pancreas. A Whipple was performed.images/1alex/10122009case6image1.jpg
images/1alex/10122009case6image2.jpg
images/1alex/10122009case6image3.jpgCorrect
Answer: Lymphoplasmacytic sclerosing pancreatitis
Histology: Three features stand out in this chronic pancreatitis. First, the inflammation is centered on the pancreatic ducts. Second, the inflammation is composed of a mixture of lymphocytes, plasma cells and eosinophils. Third, there is a venulitis.
Discussion: Lymphoplasmacytic sclerosing pancreatitis has three characterstic features, each of which is beautifully illustrated in this case. The inflammation is centered on the pancreatic ducts. The inflammation is composed of a mixture of lymphocytes, plasma cells and eosinophils, and finally there is a venulitis. Immunolabeling for IgG4 will reveal increased numbers of IgG4 expressing plasma cells, and these patients often have elevated serum IgG4 levels. This form of pancreatitis often responds to steroid therapy.
Incorrect
Answer: Lymphoplasmacytic sclerosing pancreatitis
Histology: Three features stand out in this chronic pancreatitis. First, the inflammation is centered on the pancreatic ducts. Second, the inflammation is composed of a mixture of lymphocytes, plasma cells and eosinophils. Third, there is a venulitis.
Discussion: Lymphoplasmacytic sclerosing pancreatitis has three characterstic features, each of which is beautifully illustrated in this case. The inflammation is centered on the pancreatic ducts. The inflammation is composed of a mixture of lymphocytes, plasma cells and eosinophils, and finally there is a venulitis. Immunolabeling for IgG4 will reveal increased numbers of IgG4 expressing plasma cells, and these patients often have elevated serum IgG4 levels. This form of pancreatitis often responds to steroid therapy.
