0:01

So, another entity we should be

0:03

aware of is autoimmune pancreatitis.

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As the name suggests, the underlying pathology

0:07

is autoimmune process going on in the body.

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So our body is working against our

0:11

own body, and antibodies are formed,

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and that can lead to some pseudomasses

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which can mimic pancreatic head masses.

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Or it can be sometime in the body or tail as well.

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So autoimmune pancreatitis is broadly

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divided into type 1 and type 2.

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With the type 1, the IgG4 levels are seen in the

0:33

serum as well as the tissue if you biopsy it.

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But in type 2, the IgG4 is not found.

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That is the problem.

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So if you do a blood test, it will be negative.

0:45

So in IgG1, the pancreas can be diffusely

0:48

involved, or it can be just a focal disease.

0:53

And that is the presentation which

0:56

is going to mimic with the cancer.

0:58

So diffused disease can be seen in 60 percent of

1:00

the patient with type 1, and focal disease can be

1:04

seen with 40 percent of the patient with type 1.

1:07

But that number can go high,

1:09

presenting with focal disease.

1:12

In type 2, where the serum markers were

1:14

negative, and we have no clue otherwise,

1:17

whether it is autoimmune pancreatitis or

1:19

not, in up to 85 percent of the patients.

1:23

And that, that is what mimics with the mass.

1:26

It can look like mass.

1:28

Okay?

1:30

And the point here is, the extra pancreatic

1:33

tissue involvement, like involving CVD,

1:37

or intra hepatic bile ducts, that can be seen

1:40

with type 1, but it is not present in type 2.

1:45

So we have no other clue.

1:46

Okay?

1:47

Only organ which can be involved with

1:48

type 2 is colon, ulcerative colitis,

1:52

can be present in 30 percent of the patient.

1:53

Ulcerative colitis can also be present here,

1:57

but not the way it is present in type 2.

2:02

But there could be other involvement of the

2:04

bile duct or some other tissues as well.

2:08

So the point here is, the type 2 is the one

2:11

which is going to be more controversial.

2:14

And here we play the classical role

2:17

because we diagnose that on MRs.

2:20

This can be diagnosed with IgG4,

2:22

but there is IgG4 is negative in this case.

2:25

So we are going to play a crucial role here

2:28

because we are the first person who is going to

2:29

call it a mass versus autoimmune pancreatitis

2:33

and we can prove it just by imaging, just by

2:36

following it up after the steroid is given.

2:39

The good news is if you give a steroid and

2:42

follow these patients, type 2 will never

2:45

recur back, but type 1 will recur back.

2:50

So recurrence is common. The steroid is given

2:55

to type 1, but they will never recur back.

2:57

So if we diagnose on MR, and if they're treated

3:00

with the steroid, it will never come back.

3:04

So we have a crucial role in diagnosing

3:07

autoimmune pancreatitis, and diagnosing it,

3:09

or differentiating it with the adenocarcinoma,

3:12

and we can play a very, very crucial role here.