Autoimmune Pancreatitis Accompanied with Recurrence of Bladder Cancer: Difficulty in Diagnosis and Management of Systemic Lesions in a Case with Autoimmune Pancreatitis

Hiroyuki Matsubayashi; Hirokazu Kimura; Kenichi Tobisu; Yoshifumi Onishi; Michihisa Moriguchi; Keiko Sasaki; Hiroyuki Ono

doi:10.6092/1590-8577/810

Hiroyuki Matsubayashi Division of Endoscopy, Shizuoka Cancer Center. Nagaizumi, Suntogun, Shizuoka, Japan
Hirokazu Kimura Division of Endoscopy, Shizuoka Cancer Center. Nagaizumi, Suntogun, Shizuoka, Japan
Kenichi Tobisu Division of Urology, Shizuoka Cancer Center. Nagaizumi, Suntogun, Shizuoka, Japan
Yoshifumi Onishi Division of Gastroenterology, Shizuoka Medical Center. Shimizucho, Suntogun, Shizuoka, Japan
Michihisa Moriguchi Division of Diagnostic Radiology, Shizuoka Cancer Center. Nagaizumi, Suntogun, Shizuoka, Japan
Keiko Sasaki Division of Pathology, Shizuoka Cancer Center. Nagaizumi, Suntogun, Shizuoka, Japan
Hiroyuki Ono Division of Endoscopy, Shizuoka Cancer Center. Nagaizumi, Suntogun, Shizuoka, Japan

DOI: https://doi.org/10.6092/1590-8577/810

Keywords: Autoimmunity, Diagnosis, Differential, Pancreatitis, Steroids, Urinary Bladder Neoplasms

Abstract

Context A case of autoimmune pancreatitis develops a hepatic metastasis of bladder cancer resected over 5 years before, mimicking a pseudotumor of the liver. Case report A 71-year-old man with a surgical history of bladder cancer (pT4, G2>3, N (+)) later developed autoimmune pancreatitis. Diagnosis of autoimmune pancreatitis was not problematic; however, a variety of systemic disorders appeared after the onset of autoimmune pancreatitis, possibly associated with autoimmune disorder or steroid therapy. These included pancreatic stone attack, septic shock due to ureteral stenosis, and bloody phlegm due to a lung aspergilloma. These events were not easily controlled but were managed with clinical efforts. In the following course, pelvic lymph nodes gradually enlarged and a hepatic mass occurred at 5 years and 6 months after total cystectomy. Several candidates were considered for the hepatic lesion including inflammatory pseudotumor, cholangiocellular carcinoma, and hepatic adenoma. However, percutaneous biopsy confirmed metastasis of the bladder cancer. In general, recurrence after 5 years following cystectomy is extremely rare in cases of pT4 bladder cancer with lymph node metastasis. Conclusions Patients of autoimmune pancreatitis display various problematic scenarios in diagnosis and long-term management, not only for their pancreatic lesions but also for systemic lesions.

Image: Histology of percutaneous hepatic biopsy showed urothelial carcinoma.

Downloads

Download data is not yet available.

References

Matsubayashi H, Furukawa H, Maeda A, Matsunaga K, Kanemoto H, Uesaka K, et al. Usefulness of positron emission tomography in the evaluation of distribution and activity of systemic lesions associated with autoimmune pancreatitis. Pancreatology 2009;9:694-9.

Matsubayashi H, Furukawa H, Uesaka K, Sasaki K, Ono H, Hruban RH. Autoimmune pancreatitis accompanied by cholecystitis, periaortitis and pseudotumors of the liver. Case Rep Gastroenterol 2008;2:155-61.

Okazaki K, Uchida K, Koyabu M, Miyoshi H, Takaoka M. Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease. J Gastroenterol 2011;46:277-88.

Hamano H, Kawa S, Ochi Y, Unno H, Shiba N, Wajiki M, et al. Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet 2002;359:1403-4.

Zen Y, Nakanuma Y. IgG4-related disease: a cross-sectional study of 114 cases. Am J Surg Pathol 2010;34:1812-9.

Hoes JN, Jacobs JW, Verstappen SM, Bijlsma JW, Van der Heijden GJ. Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis 2009;68:1833-8.

Matsubayashi H, Uesaka K, Kanemoto H, Kakushima N, Kimura H, Ono H. Soluble IL-2 receptor, a new marker of autoimmune pancreatitis. Pancreas 2012;41:493-6.

Matsubayashi H, Hasuike N, Onozawa Y, Kanemoto H, Ono H, Hruban RH. Autoimmune pancreatitis with response to chemoradiation therapy. JGLD 2011;20:315-9.

Matsubayashi H, Tomita H, Sugiura T, Sasaki K, Inui T, Takizawa K, et al. Autoimmune pancreatitis without a response to steroid therapy: a case which met criteria after withdrawal of steroid. Intern Med 2009;48:2087-91.

Matsubayashi H, Imai K, Kusumoto K, Ono H. Suspected autoimmune pancreatitis--an indication for steroid treatment? Dig Liv Dis 2010;42:525-6.

Maruyama M, Arakura N, Ozaki Y, Watanabe T, Ito T, Yoneda S, et al. Risk factors for pancreatic stone formation in autoimmune pancreatitis over a long-term course. J Gastroenterol 2011 [Epub ahead of print].

Heyries L, Sahel J. Endoscopic treatment of chronic pancreatitis. WJG 2007;13:6127-33.

Delhaye M, Vandermeeren A, Baize M, Cremer M. Extracorporeal shock-wave lithotripsy of pancreatic calculi. Gastroenterology 1992;102:610-20.

Sasahira N, Tada M, Isayama H, Hirano K, Nakai Y, Yamamoto N, et al. Outcomes after clearance of pancreatic stones with or without pancreatic stenting. J Gastroenterol 2007;42:63-9.

Hirano K, Isogawa A, Tada M, Isayama H, Takahara N, Miyabayashi K, et al. Long-Term Prognosis of Autoimmune Pancreatitis in Terms of Glucose Tolerance. Pancreas 2012 [Epub ahead of print].

Matsubayashi H, Sawai H, Kimura H, Yamaguchi Y, Tanaka M, Kakushima N, et al. Characteristics of autoimmune pancreatitis based on serum IgG4 level. Dig Liv Dis 2011;43:731-5.

Yao K, Hou GL, Liu ZW, Yu SL, Li YH, Zhou FJ. Upper urinary tract dilation due to conglutination of intraluminal distal ureters after orthotopic neobladder with split-cuff nipple ureteral reimplants: early results of 8 cases. Urologic Oncol 2009;27:611-6.

Hassan AA, Elgamal SA, Sabaa MA, Salem KA, Elmateet MS. Evaluation of direct versus non-refluxing technique and functional results in orthotopic Y-ileal neobladder after 12 years of follow up. Intern J Urol 2007;14:300-4.

Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19:666-75.

Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin ME, Van den Abbeele AD. Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR. 2011;196:117-22.

Steven K, Poulsen AL. Radical cystectomy and extended pelvic lymphadenectomy: survival of patients with lymph node metastasis above the bifurcation of the common iliac vessels treated with surgery only. J Urol 2007;178:1218-23; discussion 1223-4.

Herr I, Pfitzenmaier J. Glucocorticoid use in prostate cancer and other solid tumours: implications for effectiveness of cytotoxic treatment and metastases. Lancet Oncol 2006;7:425-30.

Mattern J, Buchler MW, Herr I. Cell cycle arrest by glucocorticoids may protect normal tissue and solid tumors from cancer therapy. Can Biol Ther 2007;6:1345-54.