scholarly journals Imaging of Focal Autoimmune Pancreatitis and Differentiating It from Pancreatic Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Abhishek Vijayakumar ◽  
Avinash Vijayakumar
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Clinical Presentation ◽  
Accurate Diagnosis ◽  
Imaging Modalities ◽  
Inflammatory Disorder ◽  
Serum Igg4 ◽  
Pancreatic Masses

Autoimmune pancreatitis (AIP) is an inflammatory disorder of pancreas. Two types have been identified: the diffuse and the focal or mass forming. Clinical presentation of AIP overlaps that of pancreatic cancer (PC). Sometimes serum IgG4 and CA 19-9 levels are unable to differentiate AIP from PC. Various series have shown that 5%–21% of resected pancreatic masses for suspected malignancy turned out to be AIP. Accurate diagnosis of focal AIP can avoid unnecessary surgeries. This paper elaborates the various imaging modalities useful in differentiating focal AIP from PC.

scholarly journals Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review

2018 ◽  
Vol 46 (4) ◽  
pp. 1657-1665 ◽  
Author(s):  
Wen-Ling Hsu ◽  
Shu-Min Chang ◽  
Pei-Yin Wu ◽  
Chin-Chuan Chang
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Elevated Serum ◽  
Pancreatic Head ◽  
Corticosteroid Treatment ◽  
Cancer Case ◽  
Pancreatic Lesion ◽  
Immunoglobulin G4 ◽  
Positron Emission ◽  
Serum Igg4

Autoimmune pancreatitis (AP) is a rare autoimmune pancreatic manifestation of systemic immunoglobulin G4 (IgG4)-related sclerosing disease. Distinguishing between AP and pancreatic cancer is crucial because the clinical courses, treatments, and prognoses of these two disease entities are quite different. We herein report a case involving a 52-year-old man with subacute epigastralgia who visited our hospital for evaluation of a suspicious pancreatic mass found during esophagogastroduodenoscopy. Enhanced computed tomography (CT) revealed an enlarged lesion in the pancreatic head with encasement of hepatic vessels. The lesion also exhibited increased 18F-fluorodeoxyglucose accumulation on positron emission tomography/CT imaging, which was highly suggestive of pancreatic cancer. After open biopsy, morphologic examination showed an inflammatory infiltrate in the pancreas, which was compatible with chronic sclerotic pancreatitis. Further laboratory tests revealed an elevated serum IgG4 level, and the diagnosis of sclerotic pancreatitis was then confirmed. After corticosteroid treatment, the pancreatic lesion showed shrinkage on follow-up CT, and the serum IgG4 titer decreased to the normal range. This case suggests that clinicians should be familiar with the clinical presentations and diagnostic criteria of AP versus pancreatic cancer. An awareness of the differences between these diseases may avoid misdiagnosis and unnecessary surgical intervention.

scholarly journals Untypical autoimmune pancreatitis and pancreatic cancer: differential diagnosis experiences extracted from misdiagnose of two cases

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Gaopeng Li ◽  
Ting Liu ◽  
Jian Zheng ◽  
Wenqin Kang ◽  
Jun Xu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Diagnostic Value ◽  
Warning Signs ◽  
Clear Cut ◽  
Clinical Presentations ◽  
Pet Ct ◽  
Serum Igg4 ◽  
Work Up ◽  
Rare Diagnosis

Abstract Background Differentiation between pancreatic cancer (PC) and focal form of autoimmune pancreatitis (AIP) is very challenging, with similar clinical presentations, laboratory results and morphologic imagings of US, CT, EUS, MRI, ERCP, PET-CT. Even serum IgG4 and biopsy sometimes cannot give clear-cut differential accurate diagnostis. Considering the totally different management strategy of the two diseases, accurate diagnostic value is urgently needed to remind the clinicians of the rare diagnosis of untypical AIP among frequent PC-suspected patients. Results We present 2 laparotomy cases of AIP that had a high similar characteristic to PC and retrospectively extracted the warning signs that may help select untypical AIP in PC-suspected patients. Conclusions We find that mild fluctuating jaundice with abdominal pain, young age, tumor marker of TPS, TPA and diverse results between variable radiological tests can help to differentiate AIP mass from PC, through retrospectively analyzing work-up process of AIP in two patients who underwent laparotomy for suspected PC.

scholarly journals A Case of Pancreatic Cancer in the Setting of Autoimmune Pancreatitis with Nondiagnostic Serum Markers

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Manju D. Chandrasegaram ◽  
Su C. Chiam ◽  
Nam Q. Nguyen ◽  
Andrew Ruszkiewicz ◽  
Adrian Chung ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Portal Vein ◽  
Autoimmune Pancreatitis ◽  
Squamous Metaplasia ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Serum Markers ◽  
Normal Serum ◽  
Serum Igg4 ◽  
Ca 19.9

Background. Autoimmune pancreatitis (AIP) often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP.Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a “sausage-shaped” pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS-) guided fine-needle aspiration (FNA) of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas.Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.

Serum Immunoglobulin G Fraction 4 Levels in Pancreatic Cancer: Elevations Not Associated With Autoimmune Pancreatitis

2008 ◽  
Vol 132 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Amit Raina ◽  
Alyssa M. Krasinskas ◽  
Julia B. Greer ◽  
Janette Lamb ◽  
Erin Fink ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Immunoglobulin G ◽  
Autoimmune Pancreatitis ◽  
Elevated Serum ◽  
Serum Immunoglobulin ◽  
Pancreatic Mass ◽  
Serum Igg4 Level ◽  
Serum Igg4 ◽  
Igg4 Level

Abstract Context.—Autoimmune pancreatitis is an uncommon, inflammatory disease of the pancreas that presents with clinical features, such as painless jaundice and a pancreatic mass, similar to those caused by pancreatic cancer. Patients with autoimmune pancreatitis frequently have elevated serum immunoglobulin G fraction 4 (IgG4) levels, and their pancreatic tissue may show IgG4-positive plasma cell infiltration. It is imperative to differentiate autoimmune pancreatitis from pancreatic cancer because autoimmune pancreatitis typically responds to corticosteroid treatment. A previous Japanese study reported that serum IgG4 greater than 135 mg/dL was 97% specific and 95% sensitive in predicting autoimmune pancreatitis. Objective.—To prospectively measure serum IgG4 levels in pancreatic cancer patients to ascertain whether increased levels might be present in this North American population. Design.—We collected blood samples and phenotypic information on 71 consecutive pancreatic cancer patients and 103 healthy controls who visited our clinics between October 2004 and April 2006. IgG4 levels were determined using a single radial immunodiffusion assay. A serum IgG4 level greater than 135 mg/dL was considered elevated. Results.—Five cancer patients had IgG4 elevation, with a mean serum IgG4 level of 160.8 mg/dL. None of our cancer patients with plasma IgG4 elevation demonstrated evidence of autoimmune pancreatitis. One control subject demonstrated elevated serum IgG4 unrelated to identified etiology. Conclusions.—As many as 7% of patients with pancreatic cancer have serum IgG4 levels above 135 mg/dL. In patients with pancreatic mass lesions and suspicion of cancer, an IgG4 level measuring between 135 and 200 mg/dL should be interpreted cautiously and not accepted as diagnostic of autoimmune pancreatitis without further evaluation.

Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels

Pancreatology ◽  
2014 ◽  
Vol 14 (3) ◽  
pp. S51
Author(s):  
Ming-Chu Chang ◽  
Po-Chin Liang ◽  
I-Shiow Jan ◽  
Yu-Wen Tien ◽  
Yu-Ting Chang
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Accuracy ◽  
Autoimmune Pancreatitis ◽  
Serum Igg4

Value of Serum IgG4 in the Diagnosis of Autoimmune Pancreatitis and in Distinguishing It From Pancreatic Cancer

2007 ◽  
Vol 102 (8) ◽  
pp. 1646-1653 ◽  
Author(s):  
Amaar Ghazale ◽  
Suresh T. Chari ◽  
Thomas C. Smyrk ◽  
Michael J. Levy ◽  
Mark D. Topazian ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Serum Igg4

Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels

Pancreatology ◽  
2014 ◽  
Vol 14 (5) ◽  
pp. 366-372 ◽  
Author(s):  
Ming-Chu Chang ◽  
Po-Chin Liang ◽  
Shiow Jan ◽  
Ching-Yao Yang ◽  
Yu-Wen Tien ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Accuracy ◽  
Autoimmune Pancreatitis ◽  
Serum Igg4

scholarly journals IgG4-Seronegative Autoimmune Pancreatitis and Sclerosing Cholangitis

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Allon Kahn ◽  
Anitha D. Yadav ◽  
M. Edwyn Harrison
Keyword(s):  
Autoimmune Pancreatitis ◽  
Sclerosing Cholangitis ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Comprehensive Evaluation ◽  
Elevated Serum ◽  
Igg4 Related Disease ◽  
Serum Igg4 ◽  
Type 1 Autoimmune Pancreatitis

IgG4-related disease is a relatively novel clinical entity whose gastrointestinal manifestations include type 1 autoimmune pancreatitis (AIP) and IgG4-associated sclerosing cholangitis. The presence of elevated serum IgG4 is suggestive but not essential for the diagnosis of type 1 AIP and is a pervasive feature of the proposed diagnostic criteria. The differential diagnosis of type 1 AIP includes malignant conditions, emphasizing the importance of a deliberate, comprehensive evaluation. Management of patients with a suggestive clinical presentation, but without serum IgG4 elevation, is difficult. Here we present three cases of IgG4-seronegative AIP and sclerosing cholangitis that responded to empiric steroid therapy and discuss approach considerations. These cases demonstrate the value of meticulous application of existing diagnostic algorithms to achieve a clinical diagnosis and avoid surgical intervention.

scholarly journals Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer

2019 ◽  
Vol 37 (5) ◽  
pp. 416-421 ◽  
Author(s):  
Petr Dite ◽  
Ivo Novotny ◽  
Jana Dvorackova ◽  
Bohuslav Kianicka ◽  
Martin Blaho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Differential Diagnosis ◽  
Autoimmune Pancreatitis ◽  
Diagnostic Features ◽  
Pancreatic Lesion ◽  
Immunoglobulin G4 ◽  
Normal Value ◽  
Serum Igg4 ◽  
Igg4 Level

Background: Diagnosis of pancreatic cancer (PC) in early stages is still challenging for gastroenterologists. The early detection of cancer is one of the utmost importance for the successful therapy of this malignancy. An accurate differential diagnosis of focal pancreatic lesions plays also an important role, whether it is differential diagnosis of chronic pancreatitis from PC or autoimmune pancreatitis (AIP) from PC. Raised serum immunoglobulin G4 (IgG4) levels to twice the normal value are considered one of significant diagnostic features of type 1 AIP. However, IgG4 can be increased also in patients with PC, but levels usually do not exceed twice the normal value. Methods: In years 2012–2017, IgG4 serum levels were examined in 115 patients with histologically confirmed PC. Patients with PC and elevated IgG4 level (above 135 mg/dL) had tested their histological resection specimens or bioptic specimens from pancreatic lesion, with targeted detection of the presence of IgG4 and plasmocytes in the pancreatic tissue and changes characteristic for type 1 AIP. Results: A plasmatic IgG4 level in 115 patients with diagnosed PC was higher than 135 mg/dL in 14 patients (12.2%). Out of them, 2 patients (1.7%) revealed a serum IgG4 level higher than double the normal value, that is, higher than 270.0 mg/dL (suggestive of AIP). One patient met histological criteria for diagnosis of AIP in the simultaneous presence of PC. Conclusion: Diagnosis of early cancer stages, particularly differentiating AIP from PC can be sometimes problematic. IgG4 levels can be slightly elevated also in case of PC. A targeted biopsy of the pancreas is the method of choice in cases suspected from a focal form of AIP and we recommend to prefer it over other modalities, such as, for example, response to steroid therapy.

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