Simultaneous occurrence of autoimmune pancreatitis and pancreatic cancer in patients resected for focal pancreatic mass

Mačinga, Peter; Pulkertova, Adela; Bajer, Lukáš; Malušková, Jana; Oliverius, Martin; Smejkal, Martin; Heczkova, Maria; Špičák, Julius; Hucl, Tomáš

doi:10.3748/wjg.v23.i12.2185

Cited by 20 publications

(17 citation statements)

References 39 publications

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“…Comparably, Ikeura et al found that 2 out of 3 AIP patients with PaT were females, though gender difference between the two groups didn’t reach statistical significance [8]. However, there were previous studies where the reported AIP + PaT patients were all males [9, 19]. The reason for the discrepancy between our and previous study is unknown.…”

Section: Discussioncontrasting

confidence: 90%

“…In this cohort, the delay in diagnosing the concurrent PaT was mainly attributed to the negative EUS-FNA results of pancreas at the initial visit. It indicated that the negative EUS-FNA results of pancreas couldn’t rule out the presence of PaT, which was consistent with the results of some previous studies [19, 24]. Several studies showed that serum IgG4 levels at the diagnosis of AIP were significantly higher in AIP patients with cancer than those without cancer [12, 16].…”

Section: Discussionsupporting

confidence: 85%

“…The definite association between AIP and PaT remained inconclusive. Some researchers have suggested that AIP may be a manifestation of paraneoplastic syndrome [10, 16], some have indicated that chronic pancreatic inflammation in AIP may contribute to carcinogenesis [8, 12, 19], and some have reported that AIP was not associated with an increased incidence of total malignancies [20, 21]. Our results tended to support the hypothesis of paraneoplastic syndrome, which would be briefly explained below.…”

Section: Discussionsupporting

confidence: 82%

“…Comparably, Ikeura et al also found that all of the 3 AIP patients who developed PaT showed the feature of focal pancreatic enlargement, but this characteristic didn’t differ significantly between the comparison groups [8]. When the inclusion criteria was set as focal pancreatic enlargement that underwent resection, the incidence of concurrent PaT in type 1 AIP could be as high as 33.3% (2/6) [19], which was much higher than previously mentioned. Besides, Ikeura et al found 2 out of 3 AIP + PaT patients presented with pancreatic low-density, but statistical significance was not provided [8].…”

Section: Discussionmentioning

confidence: 95%

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Pancreatic tumor in type 1 autoimmune pancreatitis: a diagnostic challenge

et al. 2019

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Background The co-occurrence of type 1 autoimmune pancreatitis (AIP) and pancreatic tumor (PaT) has been previously reported. Pure AIP cases have favorable prognosis and are primarily treated with steroids, while AIP cases with PaT are associated with poor prognosis where the primary management is pancreatic resection. However, it’s a challenge to timely identify the concurrent PaT in AIP because of their similar clinical and radiological manifestations. Methods We retrospectively reviewed the data in two medical centers from January 2010 to April 2019. The inclusion criteria were as follows: 1) completion of abdominal CT imaging before invasive procedures to the pancreas, 2) a final diagnosis of type 1 AIP using the 2011 international consensus diagnostic criteria, 3) follow-up duration of at least one month unless AIP and PaT were identified simultaneously. The presence of PaT in AIP was made based on histopathological confirmation, and the absence of PaT in AIP was defined as no pathological or radiological evidence of concurrent PaT. Clinical and radiological characteristics including gender, age, surveillance period, serum IgG4 and Ca-199 levels, biopsy, extrapancreatic involvement, CT and MR (if performed) imaging characteristics were compared between AIP with and without PaT. The Fisher’s exact test was used for qualitative variables, and nonparametric Mann-Whitney test for quantitative variables. A p value ≤0.05 was considered statistically significant. Results A total of 74 patients with type 1 AIP were included, of which 5 (6.7%) had the concurrent PaT. The subtypes were pancreatic ductal adenocarcinoma (3/5), solitary extramedullary plasmacytoma in the pancreas (1/5) and cholangiocarcinoma in the pancreatic segment (1/5), respectively. Gender ( p = 0.044), the pattern of pancreatic enlargement ( p = 0.003), heterogeneity ( p = 0.015), low-density ( p = 0.004) on CT and rim enhancement on MRI ( p = 0.050) differed significantly between AIP with and without PaT. None of the low-density characteristics on CT or other assessed MRI characteristics could significantly differentiate the two groups (p>0.05). Conclusions Female, focal pancreatic enlargement, pancreatic heterogeneity, low-density on CT and rim enhancement on MRI are suggestive of the concurrent PaT in type 1 AIP. The characteristics of low-density on CT or other MRI characteristics did not provide further diagnostic values.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 95%

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Pancreatic tumor in type 1 autoimmune pancreatitis: a diagnostic challenge

et al. 2019

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“…Some scholars have also considered that genetic factors may play a role in contributing to inflammation and oncogenesis and thus affect prognosis[22]. The exact mechanism of PDAC evolution affected by AP is unclear and needs to be further investigated[23].…”

Section: Discussionmentioning

confidence: 99%

Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

Qian¹,

Li²,

Zhang³

et al. 2019

WJG

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BACKGROUNDIn pancreatic cancer, acute pancreatitis (AP) is a serious morbidity, but its negative effect on long-term outcomes remains to be elucidated.AIMTo investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma (PDAC) and tumor-specific survival.METHODSThe medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively. The severity of acute pancreatitis was classified according to the Atlanta classification of AP. The patient demographics and tumor characteristics were assessed. Early recurrence was defined as a relapse within 12 mo after surgery. Overall and disease-free survival and recurrence patterns were analyzed. Mild acute pancreatitis was excluded because its negative effects can be negligible.RESULTSEarly recurrence in AP group was significantly higher than in non-AP group (71.4% vs 41.2%; P = 0.009). Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence [odds ratio (OR): 4.13; 95% confidence interval (CI): 1.41-12.10; P = 0.01]. The median time to recurrence was shorter in patients with AP than in those without (8.4 vs 12.8 mo; P = 0.003). Multivariate analysis identified AP as an independent prognostic factor for overall survival [relative risk (RR): 2.35; 95%CI: 1.45-3.83] and disease-free survival (RR: 2.24; 95%CI: 1.31-3.85) in patients with PDAC.CONCLUSIONPatients with moderate or severe acute pancreatitis developed recurrences earlier than those without. Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.

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