Pancreatic T-cell lymphoma with high level of soluble interleukin-2 receptor

Matsubayashi, Hiroyuki; Takagaki, Shinichi; Otsubo, Takao; Iiri, Takao; Kobayashi, Yuka; Yokota, Takashi; Shichijo, Kimitoshi; Iwafuchi, Mitsuya; Kijima, Hiroshi

doi:10.1007/s005350200143

Cited by 16 publications

(7 citation statements)

References 45 publications

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“…In contrast to the aforementioned cases, some neoplastic or malignant cases can mimic [39][40][41] or co-exist with AIP (IgG4-related diseases) [42]. PC is the most common malignancy that mimics focal-type AIP, although tumors of this type can usually be distinguished from AIP in image findings by poor enhancement while still in the delayed phase, as well as from marked dilation of the upstream pancreatic duct [2,3,43].…”

Section: Mimickers Of Aipmentioning

confidence: 99%

“…PC is the most common malignancy that mimics focal-type AIP, although tumors of this type can usually be distinguished from AIP in image findings by poor enhancement while still in the delayed phase, as well as from marked dilation of the upstream pancreatic duct [2,3,43]. By contrast, pancreatic lymphoma looks like a diffuse-type AIP, as it reveals a sausage-like, enlarged pancreas with diffuse narrowing of the main pancreatic duct [39], together with elevated levels of serum soluble interleukin-2 (IL2) receptor [44]. However, in the daily clinics, we actually encounter malignancies that are difficult to differentiate from AIPs.…”

Section: Mimickers Of Aipmentioning

confidence: 99%

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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: Mimickers Of Aipmentioning

confidence: 99%

Section: Mimickers Of Aipmentioning

confidence: 99%

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Matsubayashi

Ishiwatari

Imai

et al. 2019

IJMS

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“…A broad differential diagnosis must be kept in mind when establishing a diagnosis in a patient with a mass-forming pancreatic lesion [ 10 , 11 , 12 , 13 ]. Time is of essence as many of these lesions grow rapidly [ 10 , 11 , 12 ] and the consequences of an accurate diagnosis are significant as therapy will vary greatly from high-dose chemotherapy to immunosuppression [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Pancreatitis Accompanied by Cholecystitis, Periaortitis and Pseudotumors of the Liver

Matsubayashi¹,

Furukawa²,

Uesaka³

et al. 2008

Case Rep Gastroenterol

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A variety of extrapancreatic lesions have been associated with autoimmune pancreatitis (AIP), and these lesions can be difficult to diagnose. We report a patient referred to Shizuoka Cancer Center with the diagnosis of a possible biliary carcinoma with liver metastasis who was shown to have AIP accompanied by pseudotumors of liver. Clinical imaging revealed diffuse enlargement of the head of the pancreas with irregular narrowing of the main pancreatic duct and inferior common bile duct, multiple liver masses, mediastinal lymphadenopathy, and thickening of the wall of the gallbladder and abdominal aorta. Cytology and biopsy from the pancreaticobiliary tract was negative for malignancy. Serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) levels were in the normal range, but soluble interleukin 2 receptor (sIL2R), IgG4 and antinuclear antibody were abnormally high (sIL2R: 2,550 U/ml; IgG4: 764 mg/dl). Corticosteroid therapy was effective and these abnormal findings all improved. This case demonstrates the clinical importance of AIP accompanied by other systemic disorders in the differential diagnosis of patients with a pancreatic mass lesion.

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“…5,9,10 Sporadic cases of Hodgkin (HL) and T-cell lymphomas involving primarily the pancreatic gland have been also reported. 11,12 A diagnosis of PPL is usually obtained through percutaneous/endoscopic ultrasoundguided biopsy or exploratory laparotomy biopsy. 7 To the best of our knowledge, reports focused on PPL are limited to few research papers consisting mainly of case reports or collections.…”

Section: Introductionmentioning

confidence: 99%

Primary pancreatic lymphoma: Clinical presentation, diagnosis, treatment, and outcome

Facchinelli

Sina

Boninsegna³

et al. 2020

European J of Haematology

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Primary pancreatic lymphoma (PPL) is a rare disease representing 0.1% of malignant lymphomas, which lacks well‐defined diagnostic and therapeutic protocols. Objectives To describe PPL clinical, diagnostic and histological characteristics, together with therapy and outcome, in a relatively large series of patients. Methods The study includes 39 PPL patients, aged ≥15 years, observed from January 2005 to December 2018, in 8 Italian Institutions. Results The main symptoms were abdominal pain (58%) and jaundice (47%). Lactate dehydrogenase serum levels were elevated in 43% of patients. Histological specimens were mostly obtained by percutaneous (41%) or endoscopic (36%) biopsy, with diffuse large B‐cell lymphoma being the most frequent (69%) histological diagnosis. Chemotherapy was administered alone in 65% of patients, with radiotherapy in 17%, or after surgery in 9%. The 2‐year overall survival (OS) was 62%, the 2‐year progression‐free survival (PFS) 44%. Debulking surgery (with or without chemotherapy) was associated with a significant worse OS. Three (9.4%) of 32 high‐grade patients experienced a central nervous system (CNS) relapse. Conclusions PPL is rare, often high‐grade, with symptoms and localization similar to other pancreatic malignancies. Biopsy should be the preferred diagnostic method. High‐grade PPL should undergo CNS prophylaxis.

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Pancreatic T-cell lymphoma with high level of soluble interleukin-2 receptor

Cited by 16 publications

References 45 publications

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Autoimmune Pancreatitis Accompanied by Cholecystitis, Periaortitis and Pseudotumors of the Liver

Primary pancreatic lymphoma: Clinical presentation, diagnosis, treatment, and outcome

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