November 12, 2014
Notes: Wu, Li
Research Support, Non-U.S. Gov’t
Inflammation. 2013 Oct;36(5):1020-9. doi: 10.1007/s10753-013-9634-y.
Author Address: College of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China.
Reference Type: Journal Article
Record Number: 5226Author: Wu, W. C., Yao, X. Z., Jin da, Y., Wang, D. S., Lou, W. H. and Qin, X. Y.
Title: Clinical strategies for differentiating autoimmune pancreatitis from pancreatic malignancy to avoid unnecessary surgical resection
Journal: J Dig Dis
Short Title: Clinical strategies for differentiating autoimmune pancreatitis from pancreatic malignancy to avoid unnecessary surgical resection
Alternate Journal: Journal of digestive diseases
ISSN: 1751-2980 (Electronic)
Accession Number: 23692995
Autoimmune Diseases/*diagnosis/drug therapy/surgery
Magnetic Resonance Imaging
Pancreatitis, Chronic/*diagnosis/drug therapy/surgery
Tomography, X-Ray Computed
Abstract: OBJECTIVE: The study aimed to determine a practical strategy for differentiating between autoimmune pancreatitis (AIP) and pancreatic malignancy in order to avoid unnecessary surgical resection. METHODS: Altogether, 19 patients with AIP or other pancreatic diseases underwent routine examinations including liver function test and carbohydrate antigen 19-9, computed tomography and/or magnetic resonance imaging. Serum immunoglobulin G (IgG) and/or IgG4 was determined in patients with clinically suspected or pathologically proven AIP. Patients with suspected AIP either received diagnostic steroid therapy or laparotomy (if malignant tumors could not be excluded). Surgery was not performed in patients with a definite diagnosis of AIP by fast intraoperative frozen biopsy. Those with confirmed AIP received steroid treatment. RESULTS: In total, 15 cases were finally confirmed as AIP with eight diagnosed preoperatively, five confirmed by surgical pathology (preoperatively misdiagnosed) and two by intraoperative biopsy. Of these 15 patients with AIP and one without AIP, 14 had elevated serum gamma-globulin levels. It was proven by subsequent antibody tests that serum IgG or IgG4 were simultaneously increased. CONCLUSIONS: Elevated serum gamma-globulin level can be used as a preoperative sentinel indicator for differentiating between IgG4-related AIP and pancreatic malignancy. Serum IgG or IgG4 tests should be further performed in those with elevated serum gamma-globulin level, which helps to identify AIP in order to avoid unnecessary operation.