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

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

Basic information

Original name

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

Name (in English)

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

Authors

DÍTĚ, Petr, Ivo NOVOTNÝ, Jana DVOŘÁČKOVÁ, Bohuslav KIANIČKA, Martin BLAHO, Pavel SVOBODA, Magdalena UVÍROVÁ, Tomáš ROHAN, Hana MAŠKOVÁ and Lumír KUNOVSKÝ

Edition

Digestive Diseases : Karger. 2019, 0257-2753

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Other information

Language

Czech

Type of outcome

Článek v odborném periodiku

Field of Study

30200 3.2 Clinical medicine

Country of publisher

Czech Republic

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.493

DOI

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

Keywords (in Czech)

chronická pankreatitida, autoimunitní pankreatitida, pankreatický adenokarcinom, paraduodenální pankreatitida, pankreatický nádor, imunoglobulin G4

Keywords in English

chronic pancreatitis, autoimmune pancreatitis, pancreatic adenocarcinoma, paraduodenal pancreatitis, pancreatic tumor, immunoglobulin G4

Tags

International impact, Reviewed

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Abstract

In English

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 piays aiso an important role, whether it is differential diagnosis of chronic pan-creatitis from PC or autoimmune pancreatitis (AIP) from PC. Raised serum immunoglobulin G4 (IgG4) levels to twice the norma' value are considered one of significant diagnostic features of type 1 AIP. However, IgG4 can be increased aiso in patients with PC, but levels usually do not exceed twice the norma' value. Methods: In years 2012-2017, IgG4 serum levels were examined in 115 patients with histologically con-firmed 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 norma' value, that is, higher than 270.0 mg/dL (suggestive of AIP). One patient met histologi-cal 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.