Clinical differences between mass-forming autoimmune pancreatitis and pancreatic cancer
Clinical differences between mass-forming autoimmune pancreatitis and pancreatic cancer
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DOI：
10.3109/00365521.2012.667147
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发表时间：
2012-05-01
影响因子：
1.9
通讯作者：
Joh, Takashi
中科院分区：
文献类型：
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作者：
Naitoh, Itaru;Nakazawa, Takahiro;Joh, Takashi
Objective.自身免疫性胰腺炎（AIP）需要与胰腺癌（PC）相鉴别。我们的目的是通过比较肿块形成型AIP和PC之间的临床差异来阐明AIP的特异性发现。材料和方法。我们回顾性比较了36例肿块形成型AIP和60例无转移的PC患者的临床、影像学、血清学、组织学差异和其他器官受累（OOI）。我们评估了这些发现对AIP和PC之间的鉴别诊断的敏感性，特异性和准确性。结果AIP的CT表现为包膜样边缘，内镜逆行胰管造影（ERP）或磁共振胰胆管造影（MRCP）显示主胰管跳跃性病变，γ球蛋白> 2g/dl，OOI（胰外胆管狭窄，唾液腺肿胀和腹膜后纤维化），并通过内镜超声引导下细针穿刺的组织病理学结果排除PC。特异性> 90%的表现为IgG 4> 280 mg/dl（98%），IgG > 1800 mg/dl（97%），MPD上游最大直径< 5 mm（95%），IgG 4> 135 mg/dl（94%）。结论.肿块型AIP和PC的临床、影像学、血清学、组织学表现和OOI不同。CT表现为包膜样边缘，ERP或MRCP表现为MPD的跳跃性病变，IgG 4> 280 mg/dl，OOI为AIP的特异性表现。这些发现有助于肿块型AIP与PC的鉴别诊断。
Objective. Autoimmune pancreatitis (AIP) needs to be differentiated from pancreatic cancer (PC). We aimed to clarify the findings specific for AIP by comparing the clinical differences between mass-forming AIP and PC. Material and methods. We retrospectively compared 36 patients with mass-forming AIP and 60 with PC without metastasis regarding clinical, imaging, serological, histological differences and other organ involvement (OOI). We evaluated the sensitivity, specificity and accuracy of these findings for the differential diagnosis between AIP and PC. Results. The findings 100% specific for AIP were a capsule-like rim on computed tomography (CT), skipped lesion of main pancreatic duct (MPD) on endoscopic retrograde pancreatography (ERP) or magnetic resonance cholangiopancreatography (MRCP), gamma-globulin > 2 g/dl, OOI (extrapancreatic biliary stricture, salivary gland swelling and retroperitoneal fibrosis) and ruling out PC by histopathological findings of endoscopic ultrasonography-guided fine-needle aspiration. The findings over 90% specific were IgG4 > 280 mg/dl (98%), IgG > 1800 mg/dl (97%), maximal diameter of upstream MPD < 5 mm on MRCP (95%) and IgG4 > 135 mg/dl (94%), respectively. Conclusions. Clinical, imaging, serological, histological findings and OOI differed between mass-forming AIP and PC. Capsule-like rim on CT, skipped lesion of MPD on ERP or MRCP, IgG4 > 280 mg/dl, and OOI were highly specific findings for AIP. These findings are useful in the differential diagnosis of mass-forming AIP from PC.