Strategy for Differentiating Autoimmune Pancreatitis From Pancreatic Cancer

Kamisawa, Terumi; Imai, Michiko; Chen, Pong Yui; Tu, Yifeng; Egawa, Naoto; Tsuruta, Kouji; Okamoto, Akira; Suzuki, Mizuka; Kamata, Noriko

doi:10.1097/mpa.0b013e318175e3a0

Cited by 143 publications

(86 citation statements)

References 23 publications

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“…3b). Even when the narrowing is localized to less than one third of the entire duct, in most cases no significant dilatation is observed above the narrowed area upstream of the main duct [72][73][74][75] (Fig. 3c).…”

Section: Cq-i-mentioning

confidence: 98%

“…3d) [73,74]. If the narrowing is localized, it is necessary to consider differentiating the disease from pancreatic cancer [4,75,76]. Typical pancreatic duct features of AIP visible in ERCP images, such as side branch arising from narrowed portion or multiple stenosis of the main pancreatic duct, are useful for differential diagnosis from pancreatic cancer.…”

Section: Cq-i-mentioning

confidence: 99%

“…Typical pancreatic duct features of AIP visible in ERCP images, such as side branch arising from narrowed portion or multiple stenosis of the main pancreatic duct, are useful for differential diagnosis from pancreatic cancer. Short narrowing images of the main pancreatic duct less than 3 cm are impossible [4,75,76].…”

Section: Cq-i-mentioning

confidence: 99%

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Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 I. Concept and diagnosis of autoimmune pancreatitis

et al. 2014

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Background In response to the proposal of the international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis (AIP) and the Japanese diagnostic criteria in 2011, the 2009 Japanese consensus guidelines for managing AIP required revision. Methods Three committees [the professional committee for making clinical questions (CQs) and statements by Japanese specialists, the expert panelist committee for rating statements by the modified Delphi method, and the evaluating committee by moderators] were organized.

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Section: Cq-i-mentioning

confidence: 98%

Section: Cq-i-mentioning

confidence: 99%

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Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 I. Concept and diagnosis of autoimmune pancreatitis

et al. 2014

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“…The only retrospectively identified variable that might have distinguished between autoimmune pancreatitis and carcinoma was the presence of a discrete mass in the pancreas on CT scan [9] . Japanese investigators [10] , tried to find characteristics to discriminate autoimmune pancreatitis from pancreatic cancer and to establish a useful discriminating algorithm and diagnostic strategy. This group found no differences regarding symptoms, physical findings and the level of tumor markers.…”

mentioning

confidence: 99%

“…The Japanese strategy regarding massforming pancreatic lesions was based on imaging features of CT and endoscopic retrograde cholangiopancreatography (ERCP), and the level of IgG4. Enhancement of the enlarged pancreas, a capsule-like rim or the presence of extra-pancreatic lesions, were the features on CT scan associated with autoimmune pancreatitis [10] . None of these features were identified in the present patient.…”

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confidence: 99%

Autoimmune pancreatitis misdiagnosed as a tumor of the head of the pancreas

Brauner

Lachter²,

Ben-Ishay³

et al. 2012

WJGS

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Autoimmune pancreatitis can mimic pancreatic cancer in its clinical presentation, imaging features and laboratory parameters. Differentiating between those two entities requires implementation of clinical judgment and experience along with objective parameters that may suggest either condition. Few strategies have been proposed for the surgeon to implement when facing borderline cases. The following case is an example of a clinical scenario compatible with an accepted algorithm for diagnosis of pancreatic cancer, which eventually proved wrong. We present a 75-year-old patient who was admitted for obstructive jaundice. Imaging features were highly suggestive for pancreatic cancer as was the carbohydrate antigen 19-9 (CA 19-9) level, leading to a decision for surgery. Pathological examination revealed autoimmune pancreatitis. Though no frank carcinoma was found, premalignant ductal changes of pancreatic intraepithelial neoplasia (PanIN) Ⅰ and PanIN Ⅱ were discovered throughout the pancreatic duct. Caution is advised when relying on the combination of highly suggestive radiology features and elevated levels of CA 19-9 in the diagnosis of pancreatic cancer. When the tissue diagnosis is not conclusive, obtaining IgG4 and antinuclear Ab levels is advised, to rule out the rare possibility of autoimmune pancreatitis. Patients with autoimmune pancreatitis should be followed carefully as precancerous lesions may accompany the benign disease and the correlation of these two entities has not been ruled out.

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