Pancreatic cancer with a high serum IgG4 concentration

Abstract

Differentiation between autoimmune pancreatitis and pancreatic cancer is sometimes difficult. It has been reported that serum IgG4 concentrations are significantly elevated and particularly high (>135 mg/dL) in autoimmune pancreatitis. Measurement of serum IgG4 has become a useful tool for differentiating between autoimmune pancreatitis and pancreatic cancer. However, we present a 74-year-old female with a markedly elevated serum IgG4 (433 mg/dL) who underwent pancreaticoduodenectomy for pancreatic cancer. Elevated serum IgG4 levels continued after the resection. On histology, adenocarcinoma of the pancreas accompanied with moderate lymphoplasmacytic infiltration infiltrated the lower bile duct and duodenum, but there were no findings of autoimmune pancreatitis. Although a small metastasis was detected in one parapancreatic lymph node, regional lymph nodes were swollen. Abundant IgG4-positive plasma cells infiltrated the cancerous areas of the pancreas, but only a few IgG4-positive plasma cells were detected in the noncancerous areas. Pancreatic cancer cells were not immunoreactive for IgG4. An abundant infiltration of IgG4-positive plasma cells was detected in the swollen regional lymph nodes and in the duodenal mucosa. We believe that the serum IgG4 level was elevated in this patient with pancreatic cancer as the result of an IgG4-related systemic disease that had no clinical manifestations other than lymphadenopathy.

IgG4-related sclerosing disease clinically mimicking oral squamous cell carcinoma

“…[9][10][11] Recent reports have shown destructive IgG4 lesions involving the maxillary sinus 12 and nasal septum, 13 both of which resolved after treatment with systemic corticosteroids. Gill et al reported salivary duct carcinoma arising in IgG4-related fibrosclerosis involving the parotid gland.…”

Diagnosis and management of autoimmune pancreatitis: Experience from China

“…AIP patients frequently exhibit positive serologic antibodies, and elevated levels of γ-globulin or IgG. It has reported that elevated levels of the IgG4 were a sensitive and specific marker of AIP [36,37] ; however, elevated level of IgG4 seems nonspecific for AIP [13,38] and its role requires further study. In China, the determination of serum IgG4 level is still unavailable for most of hospitals, so we did not use it in our diagnostic criteria.…”

Pancreatitis crónica autoinmune

“…El valor diagnóstico de la ecografía transabdominal es limitado dada su poca especificidad, observándose habitualmente un páncreas aumentado hipoecoico (44). No está claramente establecido el valor de la RNM con colangiopancreatografía (44,46); no obstante se ha constatado también un aumento difuso o localizado del páncreas con baja densidad en T1 y alta en T2 (Fig. 4A).…”

“…5) (5,39,40). Con la progresión de la enfermedad, sin tratamiento, este estrechamiento tiende a extenderse a toda la extensión del conducto (46). También ha sido observado que distalmente al estrechamiento raramente existe una dilatación significativa del conducto, a diferencia de lo que comúnmente existe en la pancreatitis crónica etílica o el cáncer de páncreas (25,32,44,45).…”

“…en 2003 demuestran que en la pancreatitis autoinmune las alteraciones histopatológicas básicas observadas en tejido pancreático se observan también en otros tejidos como en los conductos biliares, ganglios linfá-ticos, tejido peripancreático y glándulas salivares, y que la infiltración se compone predominantemente de linfocitos T CD4 o CD8 y sobre todo de plasmacélulas IgG4 positivas (48), dando lugar además de la pancreatitis a colangitis esclerosante secundaria, sialoadenitis, fibrosis retroperitoneal, afectación de venas portales o flebitis obliterativa. Este patrón histopatológico ha sido posteriormente observado también en glándulas lacrimales, linfáticos mediastínicos, riñón, hígado, papila duodenal, estomago, intestino, tiroides o articulaciones, dando lugar a síndrome de Sjögren, linfadenopatías hiliares, nefritis, pseudotumor hepático, duodenitis, colitis ulcerosa, tiroiditis, artritis, con una frecuencia variable (13,25,31,33,37,46,(53)(54)(55)(56)(57).…”