Strategy for Differentiating Autoimmune Pancreatitis From Pancreatic Cancer

Strategy for Differentiating Autoimmune Pancreatitis From Pancreatic Cancer
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DOI：
10.1097/mpa.0b013e318175e3a0
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发表时间：
2008-10-01
期刊：
PANCREAS
影响因子：
2.9
通讯作者：
Kamata, Noriko
Kamata, Noriko
中科院分区：
医学4区
文献类型：
--
作者：
Kamisawa, Terumi;Imai, Mitsuho;Kamata, Noriko

文献摘要

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目的：将自身免疫性胰腺炎（AIP）与胰腺癌（PC）区分开来至关重要，因为一些 AIP 病例因怀疑患有 PC 而接受了不必要的剖腹手术或胰腺切除术。本研究旨在制定区分 AIP 和 PC 的适当策略。方法：对 17 例胰头形成肿块样病变的 AIP 患者和 70 例胰头癌患者的临床、血清学和放射学特征进行比较。结果：大量发现可用于区分 AIP 和 PC，AIP 中更可能出现以下情况：波动性黄疸；血清 IgG4 水平升高；计算机断层扫描显示增大的胰腺延迟强化和胶囊状低密度边缘；内镜逆行胰造影显示长段或跳跃式狭窄部分，有主胰管侧支，无上游扩张，胰外病变，如肝内胆管狭窄、唾液腺肿胀、腹膜后肿块等；结论：对于出现梗​​阻性黄疸和胰腺肿块的老年男性患者，鉴别诊断中应考虑 AIP。根据临床、粪便学和放射学检查结果的结合，AIP 可以与 PC 区分开来。提出了一种治疗胰头肿块样病变患者的算法。
Objectives: It is of utmost importance that autoimmune pancreatitis (AIP) be differentiated from pancreatic cancer (PC) because some AIP cases undergo unnecessary laparotomy or pancreatic resection on suspicion of PC. This study aimed to develop an appropriate strategy for differentiating between AIP and PC.Methods: Clinical, serological, and radiological features of 17 AIP patients forming a masslike lesion on pancreas head and 70 patients with pancreatic head cancer were compared.Results: Numerous findings can be used to distinguish between AIP and PC, and the following are more likely in AIP: fluctuating jaundice; elevated serum IgG4 levels; delayed enhancement of the enlarged pancreas and a capsule-like low-density rim on computed tomography; long or skipped narrowed portion with side branches of the main pancreatic duct without upstream dilatation on endoscopic retrograde pancreatography, extrapancreatic lesions, such as stenosis of the intrahepatic bile duct, salivary gland swelling, and retroperitoneal mass; and responsiveness to steroid therapy.Conclusions: In elderly male patients presenting with obstructive jaundice and a pancreatic mass, AIP should be considered in the differential diagnosis. Based on a combination of clinical, scrological, and radiological findings, AIP can be differentiated from PC. An algorithm for management of patients with a masslike lesion on pancreas head is presented.