Contributed by Russell Silowash, DO and Aatur Singhi, MD, PhD
A 60 year old female presents with jaundice and abdominal pain. Computed Tomography (CT) reveals a 4.0 cm pancreatic head mass that extends into the pancreatic body. Brushings from an Endoscopic Retrograde Choleangiopancreatography (ERCP) reveal atypical cells suspicious for malignancy. A classic pancreaticoduodenectomy was performed and pathological examination of the pancreas reveals a densely fibrotic parenchyma with moderate lymphoplasmacytic infiltrate, ductitis, neurotrophic chronic inflammation, obliterative phlebitis and atrophic acini. Immunohistochemical staining for IgG4 reveals an increased number of IgG4 plasma cells within the pancreatic parenchyma and adjacent lymphoid tissue (Figures 1 - 7). No pancreatic carcinoma is identified.