Differences in Clinical Features and Diagnostic Strategies Between IgG4-Related Autoimmune Cholangitis and Cholangiocarcinoma.
Differences in Clinical Features and Diagnostic Strategies Between IgG4-Related Autoimmune Cholangitis and Cholangiocarcinoma.
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DOI：
10.3389/fonc.2021.540904
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发表时间：
2021
影响因子：
4.7
通讯作者：
Liu C
中科院分区：
文献类型：
--
作者：
Zhu K;Yang J;Chen YZ;Zhang XR;Yu XH;Wang J;Zhang R;Liu C
IgG4相关性自身免疫性胆管炎(IgG4-AIC)往往难以与胆管细胞癌(CCA)相鉴别。本研究旨在确定一种实用的临床策略来区分IgG4-AIC和CCA，以避免不必要的手术切除。我们回顾性收集并比较了IgG4-AIC和CCA患者的临床病理资料，包括临床、血清学和放射学特征，对这些患者进行随访，以了解预后。2004年6月至2014年6月在中山大学附属中山医院接受手术切除疑似CCA的377例患者中，14例术后经组织化学确诊为IgG4-AIC。免疫组织化学结果显示，14例患者中有13例IgG4-AIC组织浆细胞表达上调。血清CA19-9水平明显低于CCA组。IgG4-AIC患者在增强CT扫描下仅见轻度或无强化，而无CCA所特有的环状或延迟强化征象。随访13例，时间12~92个月。其中3例术后定期应用强的松治疗，原有症状消失。我们的研究表明，联合应用影像和血清CA19-9可以提高术前诊断价值，减少不必要的切除率。
IgG4-related autoimmune cholangitis (IgG4-AIC) is often difficult to distinguish from cholangiocarcinoma (CCA). This study aimed to determine a practical clinical strategy for distinguishing between IgG4-AIC and CCA to avoid unnecessary surgical resection. We retrospectively collected and compared the clinicopathological data between IgG4-AIC and CCA patients, including the clinical, serological, and radiological characteristics, to follow up on these patients to investigate the prognosis. Among the 377 patients who received surgical resection for suspecting CCA at the Sun Yat-Sen Memorial Hospital between June 2004 and June 2014, 14 patients were diagnosed as IgG4-AIC through histochemistry after surgery. Immunohistochemistry revealed that IgG4 was up-regulated in the plasma cells of IgG4-AIC tissues in 13 out of 14 patients. The serum CA19-9 level was significantly lower than in the CCA group. Patients with IgG4-AIC can only see slight or no enhancement under the contrast enhancement CT scan, while there are no signs of ring-like or delayed enhancement that is unique to CCA. Thirteen patients were followed up, and the time was 12 to 92 months. Three of them were regularly treated with prednisone after surgery, and original symptoms disappeared. Our study demonstrated that the combination of imaging with serum CA19-9 could improve the preoperative diagnostic value and reduce the rate of unnecessary resection.
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