Diagnosis of Autoimmune Pancreatitis vs Neoplasms in Children With Pancreatic Mass and Biliary Obstruction

Friedlander, Joel A.; Quiros, J. Antonio; Morgan, Terry K.; Zhang, Zili; Tian, Wei; Kehr, Elizabeth; Shackleton, D.; Zigman, Andrew; Stenzel, Peter

doi:10.1016/j.cgh.2012.06.014

Cited by 36 publications

(32 citation statements)

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“…Focal changes of pancreatic parenchyma are often documented on diagnostic imaging. In view of the clinical manifestation and changes documented on imaging, pancreatic cancer followed by inflammatory masses associated with CP should be considered on differential diagnosis of AIP [2, 4, 9, 12, 17, 18]. Diagnostic imaging revealed pancreatic head masses in three of our patients with AIP.…”

Section: Discussionmentioning

confidence: 80%

Autoimmune markers in children with chronic pancreatitis

Oracz¹,

Cukrowská²,

Kierkuś³

et al. 2014

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IntroductionIn the last decade we can observe a gradual increase in the incidence of autoimmune diseases. The aetiology of chronic pancreatitis (CP) in children is varied and includes gene mutations, anatomic anomalies and others. The reported paediatric experience with chronic CP is scarce and little is known about the role of autoimmune pancreatitis (AIP).AimTo assess the frequency of autoimmune markers in children with CP.Material and methodsOne hundred and twenty-nine children hospitalised between 2005 and 2012 at the Department of Gastroenterology, The Children's Memorial Health Institute, were examined for the presence of AIP; the level of IgG4 was determined, and tests for anti-tissue antibodies (ANA, ASMA, AMA, ANCA, AHA) were conducted. Clinical data were recorded and analysed.ResultsAnti-tissue antibodies were detected in 75/129 children (58%), and 24/68 patients (35.3%) showed an increased IgG4 level. Based on the International Association of Pancreatology criteria, a suspicion of AIP was raised in 6 patients (4.6%). We found gene mutations predisposing to CP in 32/75 (42.6%) patients with autoimmune markers. In 16/75 children (21.3%), anatomic anomalies were found. There was no difference in the severity of the disease and clinical course between children with evidence of autoimmune process and patients without autoimmune markers (p = NS).ConclusionsIn children with CP, similarly to adults, there is a high frequency of biochemical markers of autoimmunity. It is worth remembering that AIP can occur in children.

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Section: Discussionmentioning

confidence: 80%

Autoimmune markers in children with chronic pancreatitis

Oracz¹,

Cukrowská²,

Kierkuś³

et al. 2014

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“…Biliary obstruction is rare [3,4]. Unlike ductal adenocarcinoma, the majority of pediatric pancreatic tumors exhibit an expansive growth pattern, and push nearby structures aside rather than invading them.…”

Section: Discussionmentioning

confidence: 96%

“…Ductal adenocarcinoma, the predominant tumor type in adults, is exceptionally rare in the pediatric population. Non-neoplastic etiologies such as autoimmune pancreatitis are also possible [4].…”

Section: Discussionmentioning

confidence: 99%

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Neuroendocrine tumor of the pancreas causing biliary obstruction in a 12 year-old girl: A case report and literature review

Bertens

Livingston

Quan

et al. 2014

Journal of Pediatric Surgery Case Reports

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a b s t r a c tPancreatic tumors are uncommon in children and rarely result in biliary obstruction. A previously well 12-year old female presented with a one-week history of fatigue, pruritis, and painless jaundice. Abdominal ultrasound demonstrated a mass in the pancreatic head associated with dilation of the common bile duct. Further workup included abdominal MRI, CT and endoscopic retrograde pancreaticogram (ERCP) with biliary stenting. Octreotide scan did not reveal uptake in the pancreatic tumor. Percutaneous biopsies were consistent with a grade 2 pancreatic neuroendocrine tumor (NET). Preoperative imaging demonstrated involvement of the portal vein. The patient was brought the operating room for a pancreaticoduodenectomy and portal vein resection. Final pathology revealed a T3N1M0 pancreatic NET. The patient recovered uneventfully.Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved.Pancreatic tumors are exceedingly rare in children and adolescents. Neuroendocrine tumors (NET) account for approximately 25% of pediatric pancreatic masses [1,2]. NET arise from endocrine tissues of the pancreas and are classified as either non-functioning or functioning. Functioning NETs secrete various peptide hormones, which act at distant sites and can result in a variety of clinical syndromes. Pancreatic NETs can be benign or malignant, however the majority of non-functioning tumors are malignant. Pancreatic tumors in children rarely present with biliary obstruction, owing to the expansive rather than infiltrative growth patterns of the common pediatric pancreatic neoplasms [3,4].

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“…8 Furthermore, the disease may present as early as the third decade and, rarely, in children as well. 9 …”

Section: Demographic Aspects Of the Diseasementioning

confidence: 99%

IgG4-Related Disease of the Gastrointestinal Tract: A 21st Century Chameleon

Deshpande

2015

Archives of Pathology &Amp; Laboratory Medicine

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Context Immunoglobulin G4 (IgG4)–related disease is a systemic fibroinflammatory disease capable of affecting virtually any organ. Although the pancreas and hepatobiliary system are commonly affected, involvement of the tubular gut is unusual. The pancreatic manifestations of this disease (autoimmune pancreatitis) often mimic pancreatic carcinoma, whereas the hepatobiliary manifestations are mistaken for cholangiocarcinoma or primary sclerosing cholangitis. The characteristic histologic features include a dense lymphoplasmacytic infiltrate, storiform-type fibrosis, and obliterative phlebitis. An increase in IgG4+ plasma cells and an IgG4 to IgG ratio of more than 40% are considered obligatory components of the diagnostic algorithm. Objective To review the challenges associated with the diagnosis of IgG4-related disease of the gastrointestinal tract. Data Sources A review of pertinent literature, along with the author's personal experience, based on institutional and consultation materials. Conclusion The complete spectrum of histologic changes is seldom captured in a biopsy specimen, and thus, the histopathology findings are best interpreted within the overall clinical context. Increased IgG4+ plasma cells are identified in a variety of benign and malignant diseases of the gastrointestinal tract.

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Diagnosis of Autoimmune Pancreatitis vs Neoplasms in Children With Pancreatic Mass and Biliary Obstruction

Cited by 36 publications

References 14 publications

Autoimmune markers in children with chronic pancreatitis

Autoimmune markers in children with chronic pancreatitis

Neuroendocrine tumor of the pancreas causing biliary obstruction in a 12 year-old girl: A case report and literature review

IgG4-Related Disease of the Gastrointestinal Tract: A 21st Century Chameleon

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