TITLE

Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma

AUTHOR(S)
Kamisawa, Terumi; Egawa, Naoto; Nakajima, Hitoshi; Tsuruta, Kouji; Okamoto, Atsutake; Kamata, Noriko
PUB. DATE
December 2003
SOURCE
American Journal of Gastroenterology;Dec2003, Vol. 98 Issue 12, p2694
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVES: Autoimmune pancreatitis (AIP) is a newly described entity with characteristic clinical, histologic, and morphologic changes, in which autoimmune mechanisms are involved in pathogenesis. However, difficulties can arise in the differentiation of AlP from pancreatic carcinoma. The aims of this study were to clarify clinical and radiologic features of AlP to elucidate areas of diagnostic confusion. METHODS: Clinical, serologic, and radiologic findings were evaluated in 17 patients with AlP. RESULTS: All 17 patients were initially suspected to have pancreatic carcinoma. The patients were predominantly elderly men who frequently presented with jaundice but without features of acute pancreatitis. Elevation of serum `y-globulin and IgG along with the presence of autoantibodies were usually evident, whereas serum tumor markers were elevated in 54% of cases. Stenosis of the bile duct was detected in 94% of cases. Diffuse enlargement of the pancreas and irregular narrowing of the main pancreatic duct were radiologically characteristic; however, segmental swelling and narrowing were detected in seven and two patients, respectively. In segmental cases, neither atrophy of the distal pancreas nor marked upstream dilation of the distal main pancreatic duct was observed. Angiographic abnormalities occurred in 54% of cases. Serologic and radiologic abnormalities showed considerable improvement with steroid therapy. CONCLUSIONS: Frequent stenosis of the bile duct, elevation of serum tumor markers, segmental pancreatic enlargement or nanowing of the main pancreatic duct, and angiographic abnormalities can cause confusion in the differential diagnosis of AlP and pancreatic carcinoma.
ACCESSION #
15182442

 

Related Articles

  • Characteristic Pancreatic Duct Appearance in Autoimmune Chronic Pancreatitis: A Case Report and Review of the Japanese Literature. Horiuchi, Akira; Kawa, Shigeyuki; Akamatsu, Taiji; Aoki, Yuji; Mukawa, Kenji; Furuya, Naoyuki; Ochi, Yasuhide; Kiyosawa, Kendo // American Journal of Gastroenterology;Feb1998, Vol. 93 Issue 2, p260 

    We report a case demonstrating the progressive narrowing of the pancreatic duct, which is presumed to he characteristic of autoimmune pancreatitis, and we review the 37 cases of chronic pancreatitis in which auto-immunity was suggested as an etiological factor in the Japanese literature. A...

  • Recurrent Attacks of Autoimmune Pancreatitis Result in Pancreatic Stone Formation. Takayama, Mari; Hamano, Hideaki; Ochi, Yasuhide; Saegusa, Hisanobu; Komatsu, Kenichi; Muraki, Takashi; Arakura, Norikazu; Imai, Yasuharu; Hasebe, Osamu; Kawa, Shigeyuki // American Journal of Gastroenterology;May2004, Vol. 99 Issue 5, p932 

    OBJECTIVES: Autoimmune pancreatitis has been characterized by irregular narrowing of the main pancreatic duct and sonolucent swelling of the parenchyma, both of which are due to lymphoplasmacytic inflammation at the active stage of the disease, and by the absence of pancreatic stone formation....

  • Pancreatic pain.  // British Medical Journal;4/17/1976, Vol. 1 Issue 6015, p921 

    Examines the mechanism of pancreatic pain. Methods employed to relieve pancreatic pain; Efficacy of pancreatic duct decompression; Interruption of the pain-carrying afferent fibers from the pancreas as alternative treatment.

  • Association of IgG4-related disease and sarcoidosis. Laure Michel // Thorax;Oct2011, Vol. 66 Issue 10, p920 

    The article focuses on the association of sarcoidosis and immunoglobulin (Ig) G4-related disease. It informs that autoimmune pancreatitis (AIP) is characterised by a high serum IgG4 concentration and IgG4-positive plasma cell tissue infiltration as well as enlarged pancreas with a narrowing of...

  • Autoimmune Pancreatitis and Diagnostic Criteria. Kawa, Shigeyuki; Fujinaga, Yasunari; Ota, Masao; Hamano, Hideaki; Bahram, Seiamak // Current Immunology Reviews;May2011, Vol. 7 Issue 2, p144 

    Autoimmune pancreatitis is a unique form of chronic pancreatitis with autoimmune phenomena, including hypergammaglobulinemia, lymphoplasmacytic infiltration, and responsiveness to corticosteroid therapy. Autoimmune pancreatitis tends to affect elderly males and it presents with pancreatic...

  • Ventral Duct Pancreaticolithiasis in Pancreas Divisum. Iannitti, David A.; Heniford, Todd; Walsh, R. Matthew // American Surgeon;Nov1998, Vol. 64 Issue 11, p1030 

    Describes the case of a 31-year-old female which represents an unusual complication of pancreas divisum with primarily ventral duct disease and pancreaticolithiasis. Causes of pancreatic ductal drainage; Recurrent abdominal pain and relapsing acute pancreatitis as common consequences of...

  • Autoantibodies in Autoimmune Pancreatitis. Smyk, Daniel S.; Rigopoulou, Eirini I.; Koutsoumpas, Andreas L.; Kriese, Stephen; Burroughs, Andrew K.; Bogdanos, Dimitrios P. // International Journal of Rheumatology;2012, p1 

    Autoimmune pancreatitis (AIP) was first used to describe cases of pancreatitis with narrowing of the pancreatic duct, enlargement of the pancreas, hyper-γ-globulinaemia, and antinuclear antibody (ANA) positivity serologically. The main differential diagnosis, is pancreatic cancer, which can...

  • Indomethacin for Post-ERCP Pancreatitis Prophylaxis: Another Attempt at the Holy Grail. Wagh, Mihir S.; Sherman, Stuart // American Journal of Gastroenterology;May2007, Vol. 102 Issue 5, p984 

    Acute pancreatitis continues to be the most dreaded complication after ERCP. Various risk factors for post-ERCP pancreatitis have now been recognized including patient-related, procedure-related, and operator-related factors. Numerous attempts at finding the ideal pharmacological agent for...

  • Variant Pancreatography. Yatto, Robert P.; Siegel, Jerome H. // American Journal of Gastroenterology;Feb1983, Vol. 78 Issue 2, p115 

    Although variation is the rule with pancreatic duct morphology, certain anomalies occur as a result of altered embryological development. These anomalies can produce obvious clinical symptomatology or may be implicated as a cause of symptoms when noted in the evaluation of patients with...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics