Clinicopathological analysis of 12 patients with autoimmune pancreatitis.
Clinicopathological analysis of 12 patients with autoimmune pancreatitis.
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DOI：
10.3892/etm.2015.2492
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发表时间：
2015-07
影响因子：
2.7
通讯作者：
Rui Zhang;Xiang-De Shi;H. Zeng;Zhaoxi Cai;Wenrui Wu;Xian-Huan Yu;Jie Wang;Chao Liu
中科院分区：
文献类型：
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作者：
Rui Zhang;Xiang-De Shi;H. Zeng;Zhaoxi Cai;Wenrui Wu;Xian-Huan Yu;Jie Wang;Chao Liu
自身免疫性胰腺炎（AIP）是一种罕见的慢性胰腺炎，常被误诊为胰腺癌（PaC）。本研究旨在探讨AIP的临床病理特点，以提高该病的诊断和治疗水平。2003年1月至2012年12月在中山纪念医院行胰十二指肠切除术的271例PaC患者中，诊断为慢性胰腺炎，并从16例患者中获得组织样本。回顾性分析16例慢性胰腺炎患者的临床病理及影像学特点。免疫组织化学法检测胰腺组织中免疫球蛋白G4 （IgG4）的表达。免疫组化结果显示，16例患者中有12例IgG4高表达，这12例患者被诊断为AIP。12例患者中，消瘦6例，黄疸、腹痛7例。16例患者中，12例血清γ-谷氨酰转移酶升高，9例血清碳水化合物抗原19-9升高。影像学表现如下：胰腺增大11例（尤其是胰头增大），胰腺缩小1例，胰腺“香肠样”改变4例，胰腺“晕征”改变5例。病理观察胰腺组织大量浆细胞浸润（11/12）及实质纤维化（8/12）。上述结果提示，影像结合IgG4表达进行诊断可以提高AIP的术前诊断价值，降低AIP的误诊率。
Autoimmune pancreatitis (AIP) is a rare type of chronic pancreatitis that is often misdiagnosed as pancreatic cancer (PaC). This study was undertaken to investigate the clinicopathological characteristics of AIP, in order to improve the diagnosis and treatment of the disease. Among the 271 patients with PaC who underwent pancreatoduodenectomy between January 2003 and December 2012 at the Sun Yat-Sen Memorial Hospital, chronic pancreatitis was identified and tissue samples obtained from 16 patients. The clinicopathological and imaging characteristics of 16 of the patients with chronic pancreatitis were analyzed retrospectively. The expression of immunoglobulin G4 (IgG4) in the pancreas tissue was detected by immunohistochemistry. Immunohistochemistry showed that IgG4 was highly expressed in 12 out of the 16 patients, and those 12 patients were diagnosed with AIP. Among those 12 patients, 6 presented with emaciation and 7 with jaundice and abdominal pain, respectively. Among the 16 included patients, 12 had an elevated level of serum γ-glutamyltransferase and 9 had an elevated level of serum carbohydrate antigen 19-9. The imaging features were as follows: Pancreatic enlargement in 11 patients (particularly pancreatic head enlargement), pancreatic miniature in 1, 'sausage-like' pancreatic changes in 4 and 'halo' sign pancreatic changes in 5. Massive plasma cell infiltration (11/12) and parenchymal fibrosis (8/12) were observed in the pancreatic tissues through pathology. These results suggest that combining imaging with IgG4 expression for the purpose of diagnosis can enhance the preoperative diagnostic value and reduce the rate of AIP misdiagnosis.