《Table 2 Outline of main features characterizing presentation of the 39 cases of hepatoid carcinoma

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《Hepatoid carcinoma of the pancreas: A case report and review of the literature》

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AFP:Alpha-fetoprotein；CEA:Carcinoembryonic antigen；IQR:Interquartile range.

Our case was highly challenging due to the clinical presentation of the patient that was inconsistent with the imaging that suggested autoimmune pancreatitis（AIP）.AIP commonly presents with obstructive jaundice，abdominal pain，vomiting and weight loss.Type 1 AIP is associated with high serum levels of IgG4（>140 mg/dL），IgG4-positive plasma cell infiltration，and sclerosis，while type 2 AIP is often associated with inflammatory bowel disease[51].The patient may have been previously diagnosed with AIP due to the“sausage-shaped”appearance of the diffusely enlarged pancreas the presence of a capsule-like rim and ductal stricture on imaging，and the lack of biopsy.Differentiating between AIP and pancreatic malignancy has become a diagnostic challenge for modern gastroenterologists because they often share overlapping clinical and imaging features.The poor response to steroid treatment prior to admission prompted reassessment of the diagnosis.The patient was cachexic with recent onset of diabetes mellitus（DM），no sign of systemic involvement，negative autoantibodies，and non-elevated amylase and lipase，indicating malignancy.Type 3C DM，as reported in the literature，is difficult to control，requiring at least 1 IU/kg body weight of insulin[52].The prevalence of DM in patients with pancreatic cancer has been reported to be 40%，with half developing DM within 2 years[53].Interestingly，DM was reported in only 6 previously reported cases（two of which had an associated neuroendocrine component and increased glucagon levels；the length of DM history was not reported in the remaining 4 cases）.In our case，it was attributed to pancreatic islet destruction resulting from advanced-stage hepatoid carcinoma with the absence of a neuroendocrine component on pathology.