Differential Diagnosis of Pancreatobiliary Carcinoma from Autoimmune Pancreatitis-Related Diseases: A Report of Three Cases

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• 作者：Michihiro Hayashi (1)
  Yoshifumi Arisaka (2)
  Atsushi Takeshita (3)
  Yusuke Tominaga (2)
  Takayuki Ki (2)
  Daisuke Masuda (2)
  Fumitoshi Hirokawa (1)
  Yutaro Egashira (3)
  Motomu Tsuji (3)
  Kazuhiro Yamamoto (4)
  Kazuhide Higuchi (2)
  Nobuhiko Tanigawa (1)
  
• 关键词：Autoimmune pancreatitis ; Sclerosing cholangitis ; Pancreatic cancer ; Bile duct cancer
• 刊名：Journal of Gastrointestinal Cancer
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：42
• 期：4
• 页码：241-251
• 全文大小：1443KB
• 参考文献：1. Okazaki K, Kawa S, Kamisawa T, Ito T, Inui K, Irie H, et al. Japanese clinical guidelines for autoimmune pancreatitis. Pancreas. 2009;38(8):849-6. CrossRef
  2. Lee TY, Kim MH, Park DH, Seo DW, Lee SK, Kim JS, et al. Utility of 18F-FDG PET/CT for differentiation of autoimmune pancreatitis with atypical pancreatic imaging findings from pancreatic cancer. AJR Am J Roentgenol. 2009;193(2):343-. CrossRef
  3. Irie H, Honda H, Baba S, Kuroiwa T, Yoshimitsu K, Tajima T, et al. Autoimmune pancreatitis: CT and MR characteristics. AJR Am J Roentgenol. 1998;170:1323-.
  4. Okazaki K, Uchida K, Ohana M, Nakase H, Uose S, Inai M, et al. Autoimmune-related pancreatitis is associated with autoantibodies and a TH1/TH2Ytype cellular immune response. Gastroenterology. 2000;118:573-1. CrossRef
  5. Pearson RK, Longnecker DS, Chari ST, Smyrk TC, Okazaki K, Frulloni L, et al. Controversies in clinical pancreatology: autoimmune pancreatitis: does it exist? Pancreas. 2003;27(1):1-3. CrossRef
  6. Vergani D, Longhi MS, Bogdanos DP, Ma Y, Mieli-Vergani G. Autoimmune hepatitis. Semin Immunopathol. 2009;31(3):421-5.
  7. Fukui T, Mitsuyama T, Takaoka M, Uchida K, Matsushita M, Okazaki K. Pancreatic cancer associated with autoimmune pancreatitis in remission. Intern Med. 2008;47(3):151-.
  8. Ghazale A, Chari S. Is autoimmune pancreatitis a risk factor for pancreatic cancer? Pancreas. 2007;35(4):376.
  9. Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol. 2007;102(8):1646-3.
  10. Deshpande V, Sainani NI, Chung RT, Pratt DS, Mentha G, Rubbia-Brandt L, et al. IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material. Mod Pathol. 2009;22(10):1287-5.
  11. Oh HC, Kim JG, Kim JW, Lee KS, Kim MK, Chi KC, et al. Early bile duct cancer in a background of sclerosing cholangitis and autoimmune pancreatitis. Intern Med. 2008;47(23):2025-.
  12. Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134(3):706-5.
  
• 作者单位：Michihiro Hayashi (1)
  Yoshifumi Arisaka (2)
  Atsushi Takeshita (3)
  Yusuke Tominaga (2)
  Takayuki Ki (2)
  Daisuke Masuda (2)
  Fumitoshi Hirokawa (1)
  Yutaro Egashira (3)
  Motomu Tsuji (3)
  Kazuhiro Yamamoto (4)
  Kazuhide Higuchi (2)
  Nobuhiko Tanigawa (1)
  
  1. Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, 569-8686, Takatsuki City, Osaka, Japan
  2. Department of Internal Medicine, Osaka Medical College Hospital, Takatsuki City, Japan
  3. Department of Pathology, Osaka Medical College Hospital, Takatsuki City, Japan
  4. Department of Radiology, Osaka Medical College Hospital, Takatsuki City, Japan
  
• ISSN：1941-6636

文摘

Background “Japanese clinical guidelines for autoimmune pancreatitis-advised to carefully differentiate between two conditions: autoimmune pancreatitis (AIP) and associated sclerosing cholangitis (SC), and pancreatobiliary malignancy. Methodology We report a series of three cases for which differential diagnosis of pancreatobiliary carcinoma from AIP and associated SC was crucial. Result Three patients presented with biliary stenosis secondary to pancreatic swelling or mass lesion, followed by further examinations: Case 1 was first diagnosed as having tumor-forming pancreatitis associated with AIP but eventually proven to be pancreatic head carcinoma; case 2 was operated for suspected bile duct cancer combined with AIP and associated cholangitis, and early cancer was found in the resected specimen; case 3 was operated on for presumed cholangiocarcinoma combined with AIP-associated SC, but no malignancy was found. Conclusions Current series of cases would raise an alert on diagnosis of AIP and associated SC, and pancreatobiliary malignancy should be carefully excluded by any means. Surgical intervention would be required in selected cases of this clinical entity.