Pancreatic carcinoma mimicking diffuse‐type autoimmune pancreatitis: Important diagnostic role of pancreatic juice cytology using endoscopic naso‐pancreatic drainage

Matsubayashi, Hiroyuki; Sasaki, Keiko; Nagata, Kaori; Kanemoto, Hideyuki; Kiuchi, Ryota; Ono, Hiroyuki

doi:10.1111/j.1751-2980.2012.00584.x

Cited by 8 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in the daily clinics, we actually encounter malignancies that are difficult to differentiate from AIPs. For instance, a case of pancreatic head cancer, with upstream pancreatic swelling due to the obstructive pancreatitis, mimics diffuse-type AIP and can lure the physician into conducting a EUS-FNAB at the wrong site [45]. A case of a sausage-like pancreas with high-levels of serum IgG4 (344 mg/dL, normal: 5-105 mg/dL) and anti-DNA antibody (14 IU/mL, normal: <6.0 IU/mL) was identified as adenocarcinoma after evaluation of a forceps biopsy from the stenotic site of the main pancreatic duct [40].…”

Section: Mimickers Of Aipmentioning

confidence: 99%

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Matsubayashi

Ishiwatari

Imai

et al. 2019

IJMS

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Mimickers Of Aipmentioning

confidence: 99%

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Matsubayashi

Ishiwatari

Imai

et al. 2019

IJMS

Self Cite

View full text Add to dashboard Cite

show abstract

“…On reviewing our presurgical examinations, we obtained diagnostic clues concerning type 1 AIP. First, we were able to reexamine ERP for the pancreatic juice cytology by placing endoscopic nasopancreatic duct drainage (16,17) and for a transpapillary biopsy from the stenotic site of the MPD. The risk associated with a pancreatic duct biopsy is thought to be low in cases with an atrophic upstream pancreas (Fig.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Our diagnostic strategy is summarized in Figure 1 In cases with a visible pancreatic mass of uncertain malignancy, EUS-FNA is performed even for masses sized ≤1 cm [91][92][93]. In cases of ductal lesions, either stenotic or ectatic, with or without (localized) pancreatic atrophy, the preferred strategy is pancreatic juice extraction for cytology using endoscopic naso-pancreatic ductal drainage (ENPD) [94,95], as small PCs tended to extend intraductally, compared with the larger ones [96]. An ENPD test should be avoided in cases with a high risk of post-ERCP pancreatitis, such as those with rich pancreatic parenchyma, a normal MPD width, pancreatic divisum, the secretion of highly viscous mucus that may stick inside an ENPD, etc.…”

Section: Pathological Sampling For the Detection Of Early Pancreatic mentioning

confidence: 99%

Surveillance of Individuals with a Family History of Pancreatic Cancer and Inherited Cancer Syndromes: A Strategy for Detecting Early Pancreatic Cancers

et al. 2019

View full text Add to dashboard Cite

A family history of pancreatic cancer (PC) is a risk factor of PC, and risk levels increase as affected families grow in number and/or develop PC at younger ages. Familial pancreatic cancer (FPC) is defined as a client having at least two PC cases in a first degree relatives. In the narrow sense, FPC does not include some inherited cancer syndromes that are known to increase the risks of PC, such as Peutz–Jeghers syndrome (PJS), hereditary pancreatitis (HP), hereditary breast ovarian cancer syndrome (HBOC), and so on. FPC accounts for 5%–10% of total PC diagnoses and is marked by several features in genetic, epidemiological, and clinicopathological findings that are similar to or distinct from conventional PC. Recent advances in genetic medicine have led to an increased ability to identify germline variants of cancer-associated genes. To date, high-risk individuals (HRIs) in many developed countries, including FPC kindreds and inherited cancer syndromes, are screened clinically to detect and treat early-stage PC. This article highlights the concept of FPC and the most recent data on its detection.

show abstract

Pancreatic carcinoma mimicking diffuse‐type autoimmune pancreatitis: Important diagnostic role of pancreatic juice cytology using endoscopic naso‐pancreatic drainage

Cited by 8 publications

References 14 publications

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

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

Surveillance of Individuals with a Family History of Pancreatic Cancer and Inherited Cancer Syndromes: A Strategy for Detecting Early Pancreatic Cancers

Contact Info

Product

Resources

About