Clinical strategies for differentiating IgG4-related cholecystitis from gallbladder carcinoma to avoid unnecessary surgical resection

Zhang, Rui; Lin, Hui‐Ping; Cai, Zhaoxi; Du, Sujuan; Zeng, Hong; Xu, Lei-Bo; Wang, Jie; Liu, Chao

doi:10.1007/s11427-019-9539-6

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…The mechanism of GPR’s relationship with poor cancer prognosis remains unclear, but studies have demonstrated the clinical effect of both GGT and PLT on GBC and related gallbladder diseases. Study on surgical resection for GBC has revealed GGT’s diagnostic value[ 16 ]. Clinically, GGT has been administered in the evaluation of gallbladder diseases such as cholangiocarcinoma[ 17 ], biliary atresia[ 18 ], and cholecystitis[ 19 ].…”

Section: Discussionmentioning

confidence: 99%

γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

Sun¹,

Guan²,

Xu³

et al. 2020

WJGO

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BACKGROUND Gallbladder carcinoma (GBC) carries a poor prognosis and requires a prediction method. Gamma-glutamyl transferase–to–platelet ratio (GPR) is a recently reported cancer prognostic factor. Although the mechanism for the relationship between GPR and poor cancer prognosis remains unclear, studies have demonstrated the clinical effect of both gamma-glutamyl transferase and platelet count on GBC and related gallbladder diseases. AIM To assess the prognostic value of GPR and to design a prognostic nomogram for GBC. METHODS The analysis involved 130 GBC patients who underwent surgery at Peking Union Medical College Hospital from December 2003 to April 2017. The patients were stratified into a high- or low-GPR group. The predictive ability of GPR was evaluated by Kaplan–Meier analysis and a Cox regression model. We developed a nomogram based on GPR, which we verified using calibration curves. The nomogram and other prognosis prediction models were compared using time-dependent receiver operating characteristic curves and the concordance index. RESULTS Patients in the high-GPR group had a higher risk of jaundice, were older, and had higher carbohydrate antigen 19-9 levels and worse postoperative outcomes. Univariate analysis revealed that GPR, age, body mass index, tumor–node–metastasis (TNM) stage, jaundice, cancer cell differentiation degree, and carcinoembryonic antigen and carbohydrate antigen 19-9 levels were related to overall survival (OS). Multivariate analysis confirmed that GPR, body mass index, age, and TNM stage were independent predictors of poor OS. Calibration curves were highly consistent with actual observations. Comparisons of time-dependent receiver operating characteristic curves and the concordance index showed advantages for the nomogram over TNM staging. CONCLUSION GPR is an independent predictor of GBC prognosis, and nomogram-integrated GPR is a promising predictive model for OS in GBC.

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Section: Discussionmentioning

confidence: 99%

γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

Sun¹,

Guan²,

Xu³

et al. 2020

WJGO

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“…It usually presents as a gallbladder wall thickening synchronous with autoimmune pancreatitis or IgG4-related sclerosing cholangitis [ 3 , 11 , 12 ], and isolated gallbladder lesions are very rare [ 8 , 9 ]. The thickening of the gallbladder wall is often diffuse [ 2 – 4 ], but it is sometimes localized, in which case, differentiation from gallbladder cancer becomes problematic [ 4 , 6 ]. Even in the presence of autoimmune pancreatitis or IgG4-associated sclerosing cholangitis, it is necessary to exclude gallbladder carcinoma, and as a result, many cases are diagnosed only after overly invasive surgical resection.…”

Section: Discussionmentioning

confidence: 99%

“…There are no definite opinions on the characteristic imaging findings of IgG4-related cholecystitis, and it is still accepted that it is difficult to distinguish it from gallbladder cancer on diagnostic imaging. Recently, however, Zhang and colleagues compared CT and MRI images of gallbladder cancer and IgG4-related cholecystitis and reported that thickening of the gallbladder wall in a layered pattern and RAS changes in the gallbladder wall are useful for differentiating the two [ 4 ]. Furthermore, patients with gallbladder cancer had lower enhancement of the nodules in the portal phase, which was not observed in patients with IgG4-related cholecystitis [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…IgG4-related disease is an immune-mediated fibroinflammatory condition characterized by frequent elevation of serum IgG4 levels, multiple organ involvement with abundant lymphocytic infiltration containing an accumulation of IgG4-positive plasma cells, and fibrosis [ 1 ]. In general, IgG4-related cholecystitis, which is a manifestation of IgG4-related disease in the gallbladder, is associated with IgG4-related diseases, such as autoimmune pancreatitis or IgG4-related sclerosing cholangitis, and presents with diffuse, circumferential thickening of the gallbladder wall in most cases [ 2 – 4 ]. However, a localized thickening type of IgG4-related cholecystitis sometimes exists [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Isolated IgG4-related cholecystitis with localized gallbladder wall thickening mimicking gallbladder cancer: a case report and literature review

et al. 2022

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Background IgG4-related cholecystitis, which is a manifestation of IgG4-related disease in the gallbladder, is associated with autoimmune pancreatitis or IgG4-related sclerosing cholangitis in most cases; isolated gallbladder lesions without systemic manifestations are very rare. Gallbladder wall thickening is often diffuse, but sometimes localized, in which case, differentiation from gallbladder cancer becomes difficult. The characteristic features of IgG4-related cholecystitis on imaging that would enable differentiation from gallbladder cancer remain poorly described. Case presentation We present a rare case of isolated IgG4-related cholecystitis with localized gallbladder wall thickening that was clinically difficult to distinguish from malignancy before resection. An 82-year-old man was referred to our hospital because of gallbladder wall thickening on abdominal ultrasonography without any symptoms. Dynamic computed tomography of the abdomen showed localized wall thickening from the body to the fundus of the gallbladder that was enhanced from an early stage with a prolonged contrast effect. There were no other findings, such as pancreatic enlargement and bile duct dilatation. Magnetic resonance cholangiopancreatography revealed neither dilatation nor stenosis of the bile duct and pancreatic duct. Endoscopic ultrasonography (EUS) showed a smooth layered thickening of the gallbladder wall with a maximum thickness of 6 mm and a well-preserved outermost hyperechoic layer in the same area. Laparoscopic cholecystectomy was performed because malignancy could not be completely ruled out. Pathological examination of a resected specimen revealed IgG4-positive plasma cell infiltration, fibrosis, and phlebitis. Although the serum IgG4 level measured after resection was normal, the condition was ultimately diagnosed as probable IgG4-related cholecystitis according to the 2020 revised comprehensive diagnostic criteria for IgG4-related disease. The EUS images reflected the pathological findings, in which lymphocytic infiltration was distributed in a laminar fashion in the gallbladder wall. Conclusions Although rare, isolated IgG4-related cholecystitis with localized wall thickening mimicking gallbladder cancer remains a clinical problem. A smooth laminar thickening of the gallbladder wall on EUS imaging could be one of the most informative characteristics for differentiating IgG4-related cholecystitis from gallbladder cancer.

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“…The stained sections were independently evaluated by two investigators who were blind to the clinical data of patients. The immunohistochemical staining sections were first scanned under a light microscope at low magnification (x40), and then five non-overlapping fields were observed at a final magnification of x400 ( 13 , 14 ). The sections were calculated by recording the number of IgG4-positive plasma cells in 10 high-power fields (HPFs, magnification, x400).…”

Section: Methodsmentioning

confidence: 99%

Differences in Clinical Features and Diagnostic Strategies Between IgG4-Related Autoimmune Cholangitis and Cholangiocarcinoma

et al. 2021

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IgG4-related autoimmune cholangitis (IgG4-AIC) is often difficult to distinguish from cholangiocarcinoma (CCA). This study aimed to determine a practical clinical strategy for distinguishing between IgG4-AIC and CCA to avoid unnecessary surgical resection. We retrospectively collected and compared the clinicopathological data between IgG4-AIC and CCA patients, including the clinical, serological, and radiological characteristics, to follow up on these patients to investigate the prognosis. Among the 377 patients who received surgical resection for suspecting CCA at the Sun Yat-Sen Memorial Hospital between June 2004 and June 2014, 14 patients were diagnosed as IgG4-AIC through histochemistry after surgery. Immunohistochemistry revealed that IgG4 was up-regulated in the plasma cells of IgG4-AIC tissues in 13 out of 14 patients. The serum CA19-9 level was significantly lower than in the CCA group. Patients with IgG4-AIC can only see slight or no enhancement under the contrast enhancement CT scan, while there are no signs of ring-like or delayed enhancement that is unique to CCA. Thirteen patients were followed up, and the time was 12 to 92 months. Three of them were regularly treated with prednisone after surgery, and original symptoms disappeared. Our study demonstrated that the combination of imaging with serum CA19-9 could improve the preoperative diagnostic value and reduce the rate of unnecessary resection.

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Clinical strategies for differentiating IgG4-related cholecystitis from gallbladder carcinoma to avoid unnecessary surgical resection

Cited by 10 publications

References 28 publications

γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

Isolated IgG4-related cholecystitis with localized gallbladder wall thickening mimicking gallbladder cancer: a case report and literature review

Differences in Clinical Features and Diagnostic Strategies Between IgG4-Related Autoimmune Cholangitis and Cholangiocarcinoma

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