Association between autoimmune pancreatitis and malignancy

Hirano, Keisuke; Isayama, Hiroyuki; Tada, Minoru; Koike, Kazuhiko

doi:10.1007/s12328-014-0486-2

Cited by 16 publications

(9 citation statements)

References 22 publications

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“…The definite association between AIP and PaT remained inconclusive. Some researchers have suggested that AIP may be a manifestation of paraneoplastic syndrome [10, 16], some have indicated that chronic pancreatic inflammation in AIP may contribute to carcinogenesis [8, 12, 19], and some have reported that AIP was not associated with an increased incidence of total malignancies [20, 21]. Our results tended to support the hypothesis of paraneoplastic syndrome, which would be briefly explained below.…”

Section: Discussionsupporting

confidence: 82%

Pancreatic tumor in type 1 autoimmune pancreatitis: a diagnostic challenge

et al. 2019

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Background The co-occurrence of type 1 autoimmune pancreatitis (AIP) and pancreatic tumor (PaT) has been previously reported. Pure AIP cases have favorable prognosis and are primarily treated with steroids, while AIP cases with PaT are associated with poor prognosis where the primary management is pancreatic resection. However, it’s a challenge to timely identify the concurrent PaT in AIP because of their similar clinical and radiological manifestations. Methods We retrospectively reviewed the data in two medical centers from January 2010 to April 2019. The inclusion criteria were as follows: 1) completion of abdominal CT imaging before invasive procedures to the pancreas, 2) a final diagnosis of type 1 AIP using the 2011 international consensus diagnostic criteria, 3) follow-up duration of at least one month unless AIP and PaT were identified simultaneously. The presence of PaT in AIP was made based on histopathological confirmation, and the absence of PaT in AIP was defined as no pathological or radiological evidence of concurrent PaT. Clinical and radiological characteristics including gender, age, surveillance period, serum IgG4 and Ca-199 levels, biopsy, extrapancreatic involvement, CT and MR (if performed) imaging characteristics were compared between AIP with and without PaT. The Fisher’s exact test was used for qualitative variables, and nonparametric Mann-Whitney test for quantitative variables. A p value ≤0.05 was considered statistically significant. Results A total of 74 patients with type 1 AIP were included, of which 5 (6.7%) had the concurrent PaT. The subtypes were pancreatic ductal adenocarcinoma (3/5), solitary extramedullary plasmacytoma in the pancreas (1/5) and cholangiocarcinoma in the pancreatic segment (1/5), respectively. Gender ( p = 0.044), the pattern of pancreatic enlargement ( p = 0.003), heterogeneity ( p = 0.015), low-density ( p = 0.004) on CT and rim enhancement on MRI ( p = 0.050) differed significantly between AIP with and without PaT. None of the low-density characteristics on CT or other assessed MRI characteristics could significantly differentiate the two groups (p>0.05). Conclusions Female, focal pancreatic enlargement, pancreatic heterogeneity, low-density on CT and rim enhancement on MRI are suggestive of the concurrent PaT in type 1 AIP. The characteristics of low-density on CT or other MRI characteristics did not provide further diagnostic values.

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Section: Discussionsupporting

confidence: 82%

Pancreatic tumor in type 1 autoimmune pancreatitis: a diagnostic challenge

et al. 2019

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“…It could be because IgG4-RD causes sustained inflammation that may induce preferable cancerous microenvironments, which resembles the mechanism of lymphoma development in association with Sjögren's syndrome 28 . However, it has been reported that surgical resection of cancer was able to cause remission of IgG4-RD 25,29 , indicating that IgG4-RD might be a type of paraneoplastic syndrome 1 . Overall, it is still too early to draw a definitive conclusion of the pathogenesis of IgG4-RD and malignancies.…”

Section: Discussionmentioning

confidence: 99%

Malignancy and IgG4-related disease: the incidence, related factors and prognosis from a prospective cohort study in China

Tang

Yang

Zhang

et al. 2020

Sci Rep

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This prospective cohort study aims to investigate the incidence, related factors and prognosis of IgG4-related disease (IgG4-RD) with malignancies in the Chinese cohort. We prospectively analyzed the IgG4-RD patients recruited in Peking Union Medical College Hospital from January 2011 to August 2018 and identified patients diagnosed with IgG4-RD complicating malignancies. Data regarding demographics, clinical features, treatment and prognosis of IgG4-RD patients complicating malignancies were collected and compared to those of age-and sex-matched controls. Among the 587 Chinese patients with IgG4-RD, 17 malignancies were identified. Ten of them developed malignancy after the diagnosis of IgG4-RD, given a standard incidence ratio (SIR) of 2.78 (95%CI 1.33-5.12). Multivariate logistic analysis indicated that autoimmune pancreatitis (OR = 6.230, 95%CI 1.559-24.907, p = 0.010) was positively associated with malignancy, whereas eosinophilia (OR = 0.094, 95%CI 0.010-0.883, p = 0.039) was negatively related with malignancies. During a median follow-up period of 61.4 ± 26.4 months, all patients with IgG4-RD and malignancies survived. We conclude that an increased incidence of malignancy was found in Chinese IgG4-RD cohort. Autoimmune pancreatitis is a potential risk factor, whereas eosinophilia is a possible protective factor for complicating malignancies.

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“…Since the aim of Hirano's study was to clarify the oncogenic effects in the presence of established IgG4-RD, they tried to address whether preceding IgG4-RD and/or type 1 AIP could cause malignant disorders. Therefore, the discrepancy between Shiokawa's and Hirano's studies can be partially explained by the fact that significant numbers of cases with concurrent cancer and AIP were included in the former study (10) whereas such cases were excluded in the latter study (12,17). Consistent with this idea, the SIR for cancer was much lower in cancer cases detected at more than one year after the diagnosis of AIP than in those detected within one year (10).…”

Section: Incidence Of Cancer In Igg4-rd and Aipmentioning

confidence: 95%

“…Although the reasons for such discrepancy have not been fully elucidated, two possibilities have been discussed (12,17). One possibility is related to dealing with patients in whom cancer and AIP occur concurrently.…”

Section: Incidence Of Cancer In Igg4-rd and Aipmentioning

confidence: 99%

Recent Updates on the Relationship between Cancer and Autoimmune Pancreatitis

et al. 2019

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Autoimmune pancreatitis (AIP) is now considered a pancreatic manifestation of a newly proposed disease condition, IgG4-related disease (IgG4-RD). IgG4-RD is characterized by enhanced IgG4 antibody responses and multiple organ involvements. Recent epidemiological studies have addressed the incidence of cancer in patients with AIP and/or IgG4-RD. Surprisingly, a significant number of AIP patients were detected with cancer at or within one year of the diagnosis of AIP. Furthermore, around 50% of all cancers detected in AIP patients comprised mainly 3 types (gastric, lung, and prostate cancer). Thus, AIP appears to be associated with cancer of other organs rather than the pancreas itself, which suggests that AIP is not a pre-cancerous condition of the pancreas. Moreover, the simultaneous occurrence of cancer and AIP in many patients has led to the establishment of an attractive concept that AIP might sometimes arise from co-existing cancers as a paraneoplastic syndrome.

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Association between autoimmune pancreatitis and malignancy

Cited by 16 publications

References 22 publications

Pancreatic tumor in type 1 autoimmune pancreatitis: a diagnostic challenge

Pancreatic tumor in type 1 autoimmune pancreatitis: a diagnostic challenge

Malignancy and IgG4-related disease: the incidence, related factors and prognosis from a prospective cohort study in China

Recent Updates on the Relationship between Cancer and Autoimmune Pancreatitis

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