Multilocular Cyst of Type 1 Autoimmune Pancreatitis Masquerading as Cancerization of Intraductal Papillary Mucinous Neoplasm

Kaneko, Junichi; Matsubayashi, Hiroyuki; Satoh, Tatsunori; Sato, Junya; Takinami, Masaki; Ishiwatari, Hirotoshi; Uesaka, Katsuhiko; Abe, Masato; Sasaki, Keiko; Ono, Hiroyuki

doi:10.2169/internalmedicine.3561-19

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…A widespread consensus on AIP image interpretation has now reduced the number of cases with diagnostic difficulty or atypical AIPs; however, a variety of atypical AIPs have been reported. These include a 9 mm, well-demarcated pancreatic mass that was not affecting the main pancreatic duct [57]; a 2 cm mass protruding inside the main pancreatic duct and mimicking a main duct-type intraductal papillary mucinous neoplasm (IPMN) [58,59]; a 3 cm, low-echoic mass concomitant with a branch-type IPMN [60]; a multilocular cyst with progression of symmetric wall thickening during the time course mimicking cancerization of a branch-type IPMN [61]; and a pancreatic mass invading the ascending colon and mimicking invasive pancreatic carcinoma [62]. Many of these lesions were not accurately diagnosed, but some did not undergo unnecessary resection due to a negative workup for malignancies using EUS-FNAB and the sequential confirmation of a steroid response [60,62].…”

Section: Atypical Cases Of Aip and Their Steroid Responsesmentioning

confidence: 99%

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Matsubayashi

Ishiwatari

Imai

et al. 2019

IJMS

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Autoimmune pancreatitis (AIP), a unique subtype of pancreatitis, is often accompanied by systemic inflammatory disorders. AIP is classified into two distinct subtypes on the basis of the histological subtype: immunoglobulin G4 (IgG4)-related lymphoplasmacytic sclerosing pancreatitis (type 1) and idiopathic duct-centric pancreatitis (type 2). Type 1 AIP is often accompanied by systemic lesions, biliary strictures, hepatic inflammatory pseudotumors, interstitial pneumonia and nephritis, dacryoadenitis, and sialadenitis. Type 2 AIP is associated with inflammatory bowel diseases in approximately 30% of cases. Standard therapy for AIP is oral corticosteroid administration. Steroid treatment is generally indicated for symptomatic cases and is exceptionally applied for cases with diagnostic difficulty (diagnostic steroid trial) after a negative workup for malignancy. More than 90% of patients respond to steroid treatment within 1 month, and most within 2 weeks. The steroid response can be confirmed on clinical images (computed tomography, ultrasonography, endoscopic ultrasonography, magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography). Hence, the steroid response is included as an optional diagnostic item of AIP. Steroid treatment results in normalization of serological markers, including IgG4. Short- and long-term corticosteroid treatment may induce adverse events, including chronic glycometabolism, obesity, an immunocompromised status against infection, cataracts, glaucoma, osteoporosis, and myopathy. AIP is common in old age and is often associated with diabetes mellitus (33–78%). Thus, there is an argument for corticosteroid therapy in diabetes patients with no symptoms. With low-dose steroid treatment or treatment withdrawal, there is a high incidence of AIP recurrence (24–52%). Therefore, there is a need for long-term steroid maintenance therapy and/or steroid-sparing agents (immunomodulators and rituximab). Corticosteroids play a critical role in the diagnosis and treatment of AIP.

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Section: Atypical Cases Of Aip and Their Steroid Responsesmentioning

confidence: 99%

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Matsubayashi

Ishiwatari

Imai

et al. 2019

IJMS

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“…Urban land use, by coordinating the relationship between land rent and use, makes reasonable arrangements for industrial land, residential land, and other types of land to meet people's needs. In this paper, we analyze in depth from several angles to improve the efficiency of comprehensive land use and solve the contradiction between not being constrained by land use and meeting the demand for land use, and the result obtained from the overall land use planning is to realize the coordination of environmental, economic, and social benefits [ 4 – 7 ]. The planning and utilization of urban land resources is no longer a matter of allocating resources at present, but also a matter of coordinating with current urban construction and citizens' working and living standards.…”

Section: Introductionmentioning

confidence: 99%

Research on Land Utilization Spatial Classification Planning Method Based on Multiocular Vision

Zhang

Wang

2022

Computational and Mathematical Methods in Medicine

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With the development of China’s social economy as well as the accelerating urbanization construction and the expanding scale of cities, the integration of land use and urban land classification based on land use spatial planning has become an important task for the sustainable development of China at present. Land use spatial classification planning is the basic basis for all kinds of development and protection construction activities, and government land use spatial planning at all levels plays an important role in implementing major national, provincial, and municipal strategies and promoting the rational and effective use of land use space. By briefly describing the spatial classification of land use and analyzing the idea of systematic integration of land use, this paper provides guidance and reference for exploring the construction of urban land use classification under land use spatial planning, aiming to improve the classification system of land use spatial planning. A neural network-based land use classification algorithm is proposed for the problems of few labeled samples of remote sensing images with high spatial resolution and feature deformation due to sensor height changes in land use spatial classification planning. By multiscale adaptive fusion of multiple convolutional layer features, the impact of feature deformation on classification accuracy is reduced. To further improve the classification accuracy, the depth features extracted from the pretraining network are used to pretrain the multiscale feature fusion part and the fully connected layer, and the whole network is fine-tuned using the augmented dataset. The experimental results show that the adaptive fusion method improves the fusion effect and effectively improves the accuracy of land use spatial classification planning.

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“…In the current case, a mass appeared at least four years after a macroscopically invisible lesion began causing a retention cyst. The authors' previously-reported AIP case ( 8 ) demonstrated that wall thickening of the multilocular cyst also appeared after two years of follow-up. Umemura et al ( 4 ) described a case of diffuse-type AIP with a long-term follow-up, involving a multilocular cyst without a mass lesion.…”

Section: Discussionmentioning

confidence: 95%

“…Of course, atypical images of pancreatic ductal adenocarcinoma or IPMN (less the mucin-secreting type) could not be denied; however, intraductal neoplasms, such as intraductal tubular neoplasm, intraductal tubulopapillary neoplasm ( 13 , 14 ), and acinar cell carcinoma ( 15 ), were suspected based on the EUS images. Thus far, cases of AIP mimicking malignant IPMN have been reported, showing nodular lesions protruding inside the MPD ( 7 ) or branch duct ( 5 , 9 ), as well as wall thickening around the multilocular cyst ( 8 ). The current case added another image variation of type 1 AIP.…”

Section: Discussionmentioning

confidence: 99%

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Type 1 Autoimmune Pancreatitis Extending along the Main Pancreatic Duct: IgG4-related Pancreatic Periductitis

et al. 2021

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We herein report a unique form of autoimmune pancreatitis (AIP) spreading along the main pancreatic duct (MPD). A 70-year-old man was referred for a small lesion at the pancreatic neck, accompanying an adjacent cyst and dilated upstream MPD. Four years earlier, health checkup images had shown a pancreatic cyst but no mass lesion. Endoscopic ultrasonography showed a contrast-enhanced, tumorous lesion, mainly occupying the MPD. With a preoperative diagnosis of ductal neoplasms mainly spreading in the MPD, Whipple's resection was performed. The resected specimens showed MPD periductitis with IgG4-related pathology, indicating type 1 AIP. Clinicians should practice caution concerning the various AIP forms.

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Multilocular Cyst of Type 1 Autoimmune Pancreatitis Masquerading as Cancerization of Intraductal Papillary Mucinous Neoplasm

Cited by 6 publications

References 21 publications

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Research on Land Utilization Spatial Classification Planning Method Based on Multiocular Vision

Type 1 Autoimmune Pancreatitis Extending along the Main Pancreatic Duct: IgG4-related Pancreatic Periductitis

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