Pancreatic Cancer Associated with Autoimmune Pancreatitis in Remission

Fukui, Toshiro; Mitsuyama, Toshiyuki; Takaoka, Makoto; Uchida, Kazushige; Matsushita, Masayuki; Okazaki, Kazuichi

doi:10.2169/internalmedicine.47.0334

Cited by 99 publications

(49 citation statements)

References 22 publications

(13 reference statements)

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“…Twelve cases of pancreatic cancer complicated with AIP have been previously reported [17][18][19][20][21] Among the 12 cases, 5 occurred concurrently with AIP, and 7 occurred from 3 to 5 years after the diagnosis of AIP. It has been estimated that, generally, two thirds of pancreatic cancers occur in the head region.…”

Section: Aip and Malignanciesmentioning

confidence: 99%

Long-Term Follow-Up of Autoimmune Pancreatitis: Characteristics of Chronic Disease and Recurrence

Kawa

Hamano

Ozaki

et al. 2009

Clinical Gastroenterology and Hepatology

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Autoimmune pancreatitis is a unique disease, characterized by lymphoplasmacytic inflammation in the acute stages. However, the active clinical features are unlikely to persist for longer periods. Through long-term follow-up, we investigated the disease course in 51 patients with autoimmune pancreatitis. We found recurrence in 21 (41%) and pancreatic stone formation in 9 (18%) patients. Pancreatic stone formation was significantly more frequent in the recurrence group (7/21; 33%), compared to the non-recurrence group (2/30; 7%). Moreover, we found high serum immunoglobulin-G4 concentrations in 13 of 175 (7.4%) patients with ordinary chronic pancreatitis. This suggested that pancreatic stone formation was closely associated with recurrence and that autoimmune pancreatitis may transform into ordinary chronic pancreatitis after several recurrences. We found that the immune complex level, with a cut-off value of 10 mg/dl, served as a good predictor of recurrence, with high sensitivity (61.9%), specificity (70.0%) and efficacy (66.7%). We also confirmed that human leukocyte antigen and cytotoxic T-lymphocyte antigen-4 polymorphism were useful predictors for autoimmune pancreatitis recurrence.3

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Section: Aip and Malignanciesmentioning

confidence: 99%

Long-Term Follow-Up of Autoimmune Pancreatitis: Characteristics of Chronic Disease and Recurrence

Kawa

Hamano

Ozaki

et al. 2009

Clinical Gastroenterology and Hepatology

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“…Recently, there have been reports in the literature of pancreatic cancer complicating AIP years after its diagnosis. [35][36][37] It is unclear if subsequent development of pancreatic cancer represents a true complication of longstanding AIP or a chance occurrencein an elderly man who also happened to have AIP. 35 Long-term studies in large cohorts of AIP are needed to determine if AIP predisposes to subsequent development of pancreatic cancer because cancer typically occurs decades after onset of chronic pancreatitis.…”

Section: Follow-upmentioning

confidence: 99%

Treatment and Relapse of Autoimmune Pancreatitis

Moon¹,

Kim²,

Park³

2008

Gut Liver

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Autoimmune pancreatitis (AIP) is a peculiar type of chronic pancreatitis whose pathogenesis involves autoimmune mechanisms. The steroid responsiveness has a significant impact on the diagnosis of AIP because patients with AIP and pancreatic cancer share many clinical features. This review focuses on the treatment and relapse of AIP. The goal of AIP treatment is remission of symptoms, serology, radiologic changes, or histology, which also applies to relapse. Although it is generally agreed that steroids should be offered to AIP patients with active disease, there is no standardized steroid regimen for AIP and no consensus on the dose and duration of steroid induction and tapering schedule, and optimal duration and dose of maintenance therapy. Obtaining a consensus on the optimal treatment regimen is very important to reducing the relapse rate. In this review, we discuss the treatment regimens used in many centers. (Gut and Liver 2008;2:1-7)

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“…Recently some researches showed that patients with IgG4-RD were at the risk of malignant tumors [10,11] or hematological malignancies such as lymphoma [12,13]. IgG4-RD can happen before or after the diagnosis of lymphoma.…”

Section: Discussionmentioning

confidence: 99%

The Expression of IgG and IgG4 in Lymphoma

Li¹,

Zhang²

2014

Intern Med

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Objectives: Although IgG4-related disease has been gradually recognized, its relationship with malignant diseases, especially lymphoma has been an eternal topic. Therefore we set out to explore the expression of IgG4 positive cells in lymphoma.Methods: Surgical excision specimens with definite diagnosis of lymphoma from January to December, 2013 were collected. Hematoxylin-eosin staining and immunohistochemical staining of IgG and IgG4 were then evaluated on dense lymphoplasmacytic infiltration, storiform fibrosis and obliterative phlebitis. For the quantification of IgG and IgG4 positive cells, the areas with the highest density of positive cells were evaluated. Three high-powered fields (hpf) in each section were analyzed, and the average number of positive cells per hpf was calculated.Results: 16 patients with lymphoma were included in our study. There were 9 males and 7 females with an average age of 51 years old. 3 cases were diagnosed as Hodgkin lymphoma while 13 were non-Hodgkin lymphoma (diffuse large B cell lymphoma 8 cases, small B cell lymphoma 2 cases, mucosa associated lymphoid tissue marginal zone B cell lymphoma (MALToma) 1 case, follicular lymphoma, peripheral T-cell lymphoma and hepatosplenic T-cell lymphoma 1 case. Dense lymphocytic infiltration accompanied by atypical lymphocytes was observed in all the specimens. Proliferation of fibrous tissue was only seen in one specimen. IgG positive cells were detectable in 14 cases with the highest cell count from 20-350/hpf. 2 Hodgkin lymphoma cases showed of IgG4 positivity with the highest cell counts were 11 and 12/hpf respectively. Conclusion:IgG4 positive cells, fibrosis and obliterative phlebitis barely appeared in lymphoma. In combination with specific tumor signature molecules, it may not be difficult to distinguish lymphoma from IgG4-related disease.

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Pancreatic Cancer Associated with Autoimmune Pancreatitis in Remission

Abstract: In January 2007, an 80-year-old

Cited by 99 publications

References 22 publications

Long-Term Follow-Up of Autoimmune Pancreatitis: Characteristics of Chronic Disease and Recurrence

Long-Term Follow-Up of Autoimmune Pancreatitis: Characteristics of Chronic Disease and Recurrence

Treatment and Relapse of Autoimmune Pancreatitis

The Expression of IgG and IgG4 in Lymphoma

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