The decrease in morbidity and mortality of pancreaticoduodenectomy in reference centers has increased the incidence of benign histopathologic diagnosis in cases where a pre-operative diagnosis of pancreatic ductal carcinoma was expected (9,2%). Recent reports have shown that autoimune pancreatitis, an entity that can lead to a pathologic diagnosis of sclerosing lymphoplasmatic pancreatitis has been the cause of about 2,5% of wrong preoperative diagnosis. Clinical and image definitive diagnosis is still uncertain on those borderline cases. An increase in IgG4 has been reported as frequent in patients with autoimune pancreatitis which can respond to steroid treatment. In doubtful cases, four diagnosis can be expected: 1. Pancreatic ductal carcinoma; 2. Chronic alcoholic pancreatitis; 3. "Chronic pancreatitis secondary to choledocal lithiasis"; 4. Sclerosing lymphoplasmatic pancreatitis. Modern medical literature sugests that evaluation of IgG4 in doubtful cases of pancreatic tumor (pseudotumor of the pancreas) could avoid unnecessary pancreaticoduodenectomies in the future.
Pancreas; Pancreaticoduodenectomy; Pancreas; Pancreatitis; Carcinoma; ductal