Pancreatic Solid Focal Lesions: Differential Diagnosis between
Autoimmune Pancreatitis and Pancreatic Cancer

J 2019

Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer

DITE, Petr, Ivo NOVOTNY, Jana DVORACKOVA, Bohuslav KIANIČKA, Martin BLAHO et. al.

Basic information

Original name

Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer

Authors

DITE, Petr (203 Czech Republic), Ivo NOVOTNY (203 Czech Republic), Jana DVORACKOVA (203 Czech Republic), Bohuslav KIANIČKA (203 Czech Republic, belonging to the institution), Martin BLAHO (203 Czech Republic), Pavel SVOBODA (203 Czech Republic), Magdalena UVIROVA (203 Czech Republic), Tomáš ROHAN (203 Czech Republic, belonging to the institution), Hana MAŠKOVÁ (203 Czech Republic, belonging to the institution) and Lumír KUNOVSKÝ (203 Czech Republic, guarantor, belonging to the institution)

Edition

Digestive Diseases, BASEL, KARGER, 2019, 0257-2753

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30219 Gastroenterology and hepatology

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.493

RIV identification code

RIV/00216224:14110/19:00110176

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1159/000499762

UT WoS

000470853800009

Keywords in English

Chronic pancreatitis; Autoimmune pancreatitis; Pancreatic adenocarcinoma; Paraduodenal pancreatitis; Pancreatic tumor; Immunoglobulin G4

Abstract

V originále

Background: Diagnosis of pancreatic cancer (PC) in early stages is still challenging for gastroenterologists. The early detection of cancer is one of the utmost importance for the successful therapy of this malignancy. An accurate differential diagnosis of focal pancreatic lesions plays also an important role, whether it is differential diagnosis of chronic pancreatitis from PC or autoimmune pancreatitis (AIP) from PC. Raised serum immunoglobulin G4 (IgG4) levels to twice the normal value are considered one of significant diagnostic features of type 1 AIP. However, IgG4 can be increased also in patients with PC, but levels usually do not exceed twice the normal value. Methods: In years 2012-2017, IgG4 serum levels were examined in 115 patients with histologically confirmed PC. Patients with PC and elevated IgG4 level (above 135 mg/dL) had tested their histological resection specimens or bioptic specimens from pancreatic lesion, with targeted detection of the presence of IgG4 and plasmocytes in the pancreatic tissue and changes characteristic for type 1 AIP. Results: A plasmatic IgG4 level in 115 patients with diagnosed PC was higher than 135 mg/dL in 14 patients (12.2%). Out of them, 2 patients (1.7%) revealed a serum IgG4 level higher than double the normal value, that is, higher than 270.0 mg/dL (suggestive of AIP). One patient met histological criteria for diagnosis of AIP in the simultaneous presence of PC. Conclusion: Diagnosis of early cancer stages, particularly differentiating AIP from PC can be sometimes problematic. IgG4 levels can be slightly elevated also in case of PC. A targeted biopsy of the pancreas is the method of choice in cases suspected from a focal form of AIP and we recommend to prefer it over other modalities, such as, for example, response to steroid therapy. (c) 2019 S. Karger AG, Basel

Citovat

DITE, Petr, Ivo NOVOTNY, Jana DVORACKOVA, Bohuslav KIANIČKA, Martin BLAHO, Pavel SVOBODA, Magdalena UVIROVA, Tomáš ROHAN, Hana MAŠKOVÁ and Lumír KUNOVSKÝ. Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer. Digestive Diseases. BASEL: KARGER, 2019, vol. 37, No 5, p. 416-421. ISSN 0257-2753. Available from: https://dx.doi.org/10.1159/000499762.

@article{1545807,
   author = {Dite, Petr and Novotny, Ivo and Dvorackova, Jana and Kianička, Bohuslav and Blaho, Martin and Svoboda, Pavel and Uvirova, Magdalena and Rohan, Tomáš and Mašková, Hana and Kunovský, Lumír},
   article_location = {BASEL},
   article_number = {5},
   doi = {http://dx.doi.org/10.1159/000499762},
   keywords = {Chronic pancreatitis; Autoimmune pancreatitis; Pancreatic adenocarcinoma; Paraduodenal pancreatitis; Pancreatic tumor; Immunoglobulin G4},
   language = {eng},
   issn = {0257-2753},
   journal = {Digestive Diseases},
   title = {Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer},
   url = {http://dx.doi.org/10.1159/000499762},
   volume = {37},
   year = {2019}
}

TY  - JOUR
ID  - 1545807
AU  - Dite, Petr - Novotny, Ivo - Dvorackova, Jana - Kianička, Bohuslav - Blaho, Martin - Svoboda, Pavel - Uvirova, Magdalena - Rohan, Tomáš - Mašková, Hana - Kunovský, Lumír
PY  - 2019
TI  - Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer
JF  - Digestive Diseases
VL  - 37
IS  - 5
SP  - 416-421
EP  - 416-421
PB  - KARGER
SN  - 02572753
KW  - Chronic pancreatitis
KW  - Autoimmune pancreatitis
KW  - Pancreatic adenocarcinoma
KW  - Paraduodenal pancreatitis
KW  - Pancreatic tumor
KW  - Immunoglobulin G4
UR  - http://dx.doi.org/10.1159/000499762
L2  - http://dx.doi.org/10.1159/000499762
N2  - Background: Diagnosis of pancreatic cancer (PC) in early stages is still challenging for gastroenterologists. The early detection of cancer is one of the utmost importance for the successful therapy of this malignancy. An accurate differential diagnosis of focal pancreatic lesions plays also an important role, whether it is differential diagnosis of chronic pancreatitis from PC or autoimmune pancreatitis (AIP) from PC. Raised serum immunoglobulin G4 (IgG4) levels to twice the normal value are considered one of significant diagnostic features of type 1 AIP. However, IgG4 can be increased also in patients with PC, but levels usually do not exceed twice the normal value. Methods: In years 2012-2017, IgG4 serum levels were examined in 115 patients with histologically confirmed PC. Patients with PC and elevated IgG4 level (above 135 mg/dL) had tested their histological resection specimens or bioptic specimens from pancreatic lesion, with targeted detection of the presence of IgG4 and plasmocytes in the pancreatic tissue and changes characteristic for type 1 AIP. Results: A plasmatic IgG4 level in 115 patients with diagnosed PC was higher than 135 mg/dL in 14 patients (12.2%). Out of them, 2 patients (1.7%) revealed a serum IgG4 level higher than double the normal value, that is, higher than 270.0 mg/dL (suggestive of AIP). One patient met histological criteria for diagnosis of AIP in the simultaneous presence of PC. Conclusion: Diagnosis of early cancer stages, particularly differentiating AIP from PC can be sometimes problematic. IgG4 levels can be slightly elevated also in case of PC. A targeted biopsy of the pancreas is the method of choice in cases suspected from a focal form of AIP and we recommend to prefer it over other modalities, such as, for example, response to steroid therapy. (c) 2019 S. Karger AG, Basel
ER  -

DITE, Petr, Ivo NOVOTNY, Jana DVORACKOVA, Bohuslav KIANIČKA, Martin BLAHO, Pavel SVOBODA, Magdalena UVIROVA, Tomáš ROHAN, Hana MAŠKOVÁ and Lumír KUNOVSKÝ. Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer. \textit{Digestive Diseases}. BASEL: KARGER, 2019, vol.~37, No~5, p.~416-421. ISSN~0257-2753. Available from: https://dx.doi.org/10.1159/000499762.

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