| Theme | Benign to Low-malignant Pancreatobiliary Lesionst | |
|---|---|---|
| Title | Autoimmune Pancreatitis | |
| Publish Date | 2011/05 | |
| Author | Terumi Kamisawa | Departments of Internal Medicine, Tokyo Metropolitan Komagome Hospital |
| Author | Kensuke Takuma | Departments of Internal Medicine, Tokyo Metropolitan Komagome Hospital |
| Author | Taku Tabata | Departments of Internal Medicine, Tokyo Metropolitan Komagome Hospital |
| Author | Yoshihiko Inaba | Departments of Internal Medicine, Tokyo Metropolitan Komagome Hospital |
| Author | Naoto Egawa | Departments of Internal Medicine, Tokyo Metropolitan Komagome Hospital |
| [ Summary ] | Useful findings to differentiate autoimmune pancreatitis (AIP) from pancreatic cancer are as follows：elevation of serum IgG4 levels, diffuse enlargement of the pancreas, delayed enhancement and a capsule-like rim observed with enhanced CTs or MRIs, a high signal intensity area observed with diffusion-weighted MRIs, extrapancreatic lesions with FDG-PET scans, and long or skipped irregular narrowing of the main pancreatic duct on ERCP. EUS-FNA can be used to deny the existence of cancer but histological diagnosis of AIP is rarely made by employing EUS-FNA. Steroid responsiveness is useful for confirmation of diagnosis of AIP in some cases. Differential diagnosis between IgG4-related sclerosing cholangitis and bile duct cancer is sometimes difficult, especially in bile-cytology negative cases. Elevation of serum IgG4 levels, association with other sclerosing diseases, and extensive thickness of the bile duct wall suggest IgG4-related sclerosing cholangitis rather than bile duct cancer. Steroid responsiveness may be a useful diagnostic indicator for diagnosis of IgG4-related sclerosing cholangitis. | |