Recent Updates on the Relationship between Cancer and Autoimmune Pancreatitis

Abstract

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.

Early pancreatic cancer in IgG4-related pancreatic mass: A case report

“…Furthermore, in a recent review by Okamoto et al[4], not only the correlation between these entities is refused, but also AIP is considered as a paraneoplastic syndrome of PC and not its determinant. There is agreement that chronic inflammation is a major determinant of biliopancreatic malignancies due to chronic pancreatitis and autoimmune cholangiopathy being well recognized risk factors[14].…”

“…IgG4-mediated disease is a systemic condition that can manifest in various clinical forms, including autoimmune pancreatitis (AIP type 1) and IgG4-related cholangiopathy[1-3]. It is well known that chronic pancreatitis is a physiopathological model for pancreatic adenocarcinoma (PAC), but there is no firm evidence that AIP can serve as a pathway for pancreatic neoplasm[4]. We are reporting a very unusual cause of pancreatic cancer (PC) triggered in a previously unknown IgG4-related disease.…”

European Guideline on IgG4‐related digestive disease – UEG and SGF evidence‐based recommendations

“…However, these data might be influenced by a bias due to a more careful surveillance of patients with IgG4‐related disease or AIP. Thus, future prospective studies are required to analyse the incidence of cancer in patients with IgG4‐related disease compared to age‐, sex‐, and risk factor‐matched control subjects 189 …”

Immunoglobulin G4‐related disease in a dog

“…The IgG4 antibodies in affected human patients appear to target annexin A11 in an autoimmune manner, but the exact pathogenesis of the disease is uncertain because IgG4 typically is thought to have anti‐inflammatory functions . Other investigations indicate that IgG4‐RD may be a paraneoplastic response …”