Differentiation of Autoimmune Pancreatitis from Pancreatic Cancer Remains Challenging
Differentiation of Autoimmune Pancreatitis from Pancreatic Cancer Remains Challenging
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DOI：
10.1007/s00268-019-04928-w
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发表时间：
2019-06-01
影响因子：
2.6
通讯作者：
Yip, V. S.
中科院分区：
文献类型：
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作者：
Dickerson, L. D.;Farooq, A.;Yip, V. S.
背景自身免疫性胰腺炎（AIP）是一种少见的慢性胰腺炎.虽然对皮质类固醇有反应，但AIP在放射学上常常伪装成胰腺肿瘤。我们的目的是评估人口统计学，放射学和组织学特征，在我们的队列，以区分AIP从pancreatic malignancy.MethodsClinical，生化，组织学和放射学的所有AIP患者1997年至2016年的详细资料进行了分析。最初的成像重新审查，根据国际准则由三个盲独立的放射科医生，以评估与自身免疫性胰腺炎和胰腺cancer.ResultsThere相关的功能共有45例：25在类型1（55.5%），14类型2（31.1%）和6 AIP，否则未指定（13.3%）。中位（IQR）年龄为57（51-70）岁。30例患者（66.6%）为男性。26例患者（57.8%）因疑似恶性肿瘤而切除，1例因症状性慢性胰腺炎而切除。3例经组织学证实为恶性肿瘤，同时伴有AIP。两名患者在切除术后死于胰腺癌复发。基于放射学和临床病史的多学科团队审查决定了管理。切除患者（与非切除组相比）年龄更大（64 vs. 53，p=0.003），更常合并自身免疫性病变（22.2 vs. 55.6%，p=0.022）。切除的患者还表现出不太典型的AIP放射学特征，即光晕征（0/25 vs. 3/17，p=0.029）和胰腺裂缺失（18/25 vs. 17/17，p=0.017）。有没有差异，人口统计学特征以外的年龄。结论尽管国际指南诊断AIP，胰腺癌的分化仍然具有挑战性。在怀疑癌症或保守治疗失败的情况下，切除仍然是一种重要的治疗选择。
BackgroundAutoimmune pancreatitis (AIP) is an uncommon form of chronic pancreatitis. Whilst being corticosteroid responsive, AIP often masquerades radiologically as pancreatic neoplasia. Our aim is to appraise demographic, radiological and histological features in our cohort in order to differentiate AIP from pancreatic malignancy.MethodsClinical, biochemical, histological and radiological details of all AIP patients 1997-2016 were analysed. The initial imaging was re-reviewed according to international guidelines by three blinded independent radiologists to evaluate features associated with autoimmune pancreatitis and pancreatic cancer.ResultsThere were a total of 45 patients: 25 in type 1 (55.5%), 14 type 2 (31.1%) and 6 AIP otherwise not specified (13.3%). The median (IQR) age was 57 (51-70) years. Thirty patients (66.6%) were male. Twenty-six patients (57.8%) had resection for suspected malignancy and one for symptomatic chronic pancreatitis. Three had histologically proven malignancy with concurrent AIP. Two patients died from recurrent pancreatic cancer following resection. Multidisciplinary team review based on radiology and clinical history dictated management. Resected patients (vs. non-resected group) were older (64 vs. 53, p=0.003) and more frequently had co-existing autoimmune pathologies (22.2 vs. 55.6%, p=0.022). Resected patients also presented with less classical radiological features of AIP, which are halo sign (0/25 vs. 3/17, p=0.029) and loss of pancreatic clefts (18/25 vs. 17/17, p=0.017). There were no differences in demographic features other than age.ConclusionDespite international guidelines for diagnosing AIP, differentiation from pancreatic cancer remains challenging. Resection remains an important treatment option in suspected cancer or where conservative treatment fails.