#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Autoimmune pancreatitis in patients resected for focal pancreatic lesion – first results


Authors: P. Mačinga 1;  J. Malušková 2;  M. Oliverius 3;  J. Špičák 1;  T. Hucl 1
Authors place of work: Klinika hepatogastroenterologie, IKEM, Praha 1;  Oddělení patologie, IKEM, Praha 2;  Klinika transplantační chirurgie, IKEM, Praha 3
Published in the journal: Gastroent Hepatol 2014; 68(4): 340-345
Category: Clinical and Experimental Gastroenterology: Original Article

Summary

Autoimmune pancreatitis (AIP) is a rare disease that may present with signs and symptoms mimicking pancreatic cancer (PC). AIP is characterized by a dramatic response to corticosteroid therapy. Despite the availability of well-defined AIP diagnosis criteria, a large portion of AIP patients is still indicated for unnecessary resection surgery.

Aim:
To assess the proportion of AIP in all pancreatic resections performed in the Institute of Clinical and Experimental Medicine for suspected focal pancreatic and to determine the clinical characteristics of this subgroup.

Methods:
A retrospective analysis of the data of all patients who underwent pancreatic resection in the Institute of Clinical and Experimental Medicine for suspected cancer between January 2000 and July 2013.

Results:
Two hundred and ninety-five pancreatic resections were performed in 201 males and 94 females (the mean age of patients was 60 years, range 36–78 years). In 15 patients (5.1%, 12 males, 3 females, average age 55), AIP was diagnosed based on the histology of the resected specimen. In six AIP patients (40%, all males, 3 AIP type 1, 3 AIP type 2), pancreatic adenocarcinoma (PC) was also present in the resected tissue. Except for higher age and new-onset diabetes in the group with PC, no significant differences were observed in the preoperative characteristics of patients with AIP with and without cancer. The diagnosis of AIP was not made in any of the patients prior to surgery; however, the diagnostic algorithm was not fully completed.

Conclusion:
The considerable number of cases of AIP found in pancreas tissue resected for focal pancreatic lesion confirms the challenge of AIP diagnostics. The high incidence of PC in patients with AIP should draw attention to the possibility of synchronous AIP and PC occurrence; it may also indicate the possibility of AIP being a risk factor of PC. Patients with AIP and PC were older and were diagnosed with new-onset diabetes mellitus more frequently.

Key words:
autoimmune pancreatitis – pancreatic cancer – diabetes mellitus

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
28. 7. 2014

Accepted:
11. 8. 2014


Zdroje

1. Sarles H, Sarles JC, Camatte R et al. Observations on 205 confirmed cases of acute pancreatitis, recurring pancreatitis, and chronic pancreatitis. Gut 1965; 6(6): 545–559.

2. Yoshida K, Toki F, Takeuchi T et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995; 40(7): 1561–1568.

3. Hart PA, Kamisawa T, Brugge WR et al. Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut 2013; 62(12): 1771–1776. doi: 10.1136/gutjnl-2012-303617.

4. Okazaki K, Kawa S, Kamisawa T et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol 2006; 41(7): 626–631.

5. Kim KP, Kim MH, Kim JC et al. Diagnostic criteria for autoimmune chronic pancreatitis revisited. World J Gastroenterol 2006; 12(16): 2487–2496.

6. Chari ST, Smyrk TC, Levy MJ et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 2006; 4(8): 1010–1016.

7. Shimosegawa T, Chari ST, Frulloni L et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011; 40(3): 352–358. doi: 10.1097/MPA.0b013e3182142fd2.

8. Sugumar A, Chari S. Autoimmune pancreatitis: an update. Expert Rev Gastroenterol Hepatol 2009; 3(2): 197–204. doi: 10.1586/egh.09.2.

9. Clark CJ, Morales-Oyarvide V, Zaydfudim V et al. Short-term and long-term outcomes for patients with autoimmune pancreatitis after pancreatectomy: a multi-institutional study. J Gastrointest Surg 2013; 17(5): 899–906. doi: 10.1007/s11605-013-2145-1.

10. Ghazale A, Chari S. Is autoimmune pancreatitis a risk factor for pancreatic cancer? Pancreas 2007; 35(4): 376.

11. Fukui T, Mitsuyama T, Takaoka M et al. Pancreatic cancer associated with autoimmune pancreatitis in remission. Intern Med 2008; 47(3): 151–155.

12. Loos M, Esposito I, Hedderich DM et al. Autoimmune pancreatitis complicated by carcinoma of the pancreatobiliary system: a case report and review of the literature. Pancreas 2011; 40(1): 151–154. doi: 10.1097/MPA.0b013e3181f74a13.

13. Chandrasegaram MD, Chiam SC, Nguyen NQ et al. A case of pancreatic cancer in the setting of autoimmune pancreatitis with nondiagnostic serum markers. Case Rep Surg 2013: 809023. doi: 10.1155/2013/809023.

14. Dite P, Nechutova H, Uvirova M et al. Autoimmune pancreatitis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158(1): 17–22. doi: 10.5507/bp.2013.094.

15. Lowenfels AB, Maisonneuve P, Cavallini G et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993; 328(20): 1433–1437.

16. Raimondi S, Lowenfels AB, Morselli--Labate AM et al. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol 2010; 24(3): 349–358. doi: 10.1016/j.bpg.2010.02.007.

17. Hucl T. Karcinom pankreatu. Gastroent Hepatol 2012; 66(5): 350–356.

18. Gupta R, Khosroshahi A, Shinagare S et al. Does autoimmune pancreatitis increase the risk of pancreatic carcinoma? A retrospective analysis of pancreatic resections. Pancreas 2013; 42(3): 506–510. doi: 10.1097/MPA.0b013e31826bef91.

19. Kamisawa T, Tsuruta K, Okamoto A et al. Frequent and significant K-ras mutation in the pancreas, the bile duct, and the gallbladder in autoimmune pancreatitis. Pancreas 2009; 38(8): 890–895. doi: 10.1097/MPA.0b013e3181b65a1c.

20. Velayos FS, Terdiman JP, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol 2005; 100(6): 1345–1353.

21. Maire F, Le Baleur Y, Rebours V et al. Outcome of patients with type 1 or 2 autoimmune pancreatitis. Am J Gastroenterol 2011; 106(1): 151–156. doi: 10.1038/ajg.2010.314.

22. Maruyama M, Watanabe T, Kanai K et al. Autoimmune pancreatitis can develop into chronic pancreatitis. Orphanet J Rare Dis 2014; 9: 77. doi: 10.1186/1750-1172-9-77.

23. Kawa S, Maruyama M, Watanabe T. Prognosis and long term outcomes of autoimmune pancreatitis. The Pancreapedia: Exocrine Pancreas Knowledge Base. 2013 [online]. Available from: http://www.pancreapedia.org/reviews/prognosis-and-long-term-outcomes-of-autoimmune-pancreatitis.

24. Pannala R, Basu A, Petersen GM et al. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol 2009; 10(1): 88–95. doi: 10.1016/S1470-2045(08)70337-1.

25. Dhall D, Suriawinata AA, Tang LH et al. Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis. Hum Pathol 2010; 41(5): 643–652. doi: 10.1016/j.humpath.2009.10.019.

Štítky
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Článok vyšiel v časopise

Gastroenterology and Hepatology

Číslo 4

2014 Číslo 4
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#