Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma

Kamisawa, Terumi; Egawa, Naoto; Nakajima, Hitoshi; Tsuruta, Kouji; Okamoto, Atsutake; Kamata, Noriko
December 2003
American Journal of Gastroenterology;Dec2003, Vol. 98 Issue 12, p2694
Academic Journal
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.


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