title: Strategy to differentiate autoimmune pancreatitis from pancreas cancer.
abstract: Autoimmune pancreatitis (AIP) is a newly described entity of pancreatitis in which the pathogenesis appears to involve autoimmune mechanisms. Based on histological and immunohistochemical examinations of various organs of AIP patients, AIP appears to be a pancreatic lesion reflecting a systemic "IgG4-related sclerosing disease". Clinically, AIP patients and patients with pancreatic cancer share many features, such as preponderance of elderly males, frequent initial symptom of painless jaundice, development of new-onset diabetes mellitus, and elevated levels of serum tumor markers. It is of uppermost importance not to misdiagnose AIP as pancreatic cancer. Since there is currently no diagnostic serological marker for AIP, and approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological, and histopathological features. Findings suggesting AIP rather than pancreatic cancer include: fluctuating obstructive jaundice; elevated serum IgG4 levels; diffuse enlargement of the pancreas; delayed enhancement of the enlarged pancreas and presence of a capsule-like rim on dynamic computed tomography; low apparent diffusion coefficient values on diffusion-weighted magnetic resonance image; irregular narrowing of the main pancreatic duct on endoscopic retrograde cholangiopancreatography; less upstream dilatation of the main pancreatic duct on magnetic resonance cholangiopancreatography, presence of other organ involvement such as bilateral salivary gland swelling, retroperitoneal fibrosis and hilar or intrahepatic sclerosing cholangitis; negative work-up for malignancy including endoscopic ultrasound-guided fine needle aspiration; and steroid responsiveness. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takuma
authors.forename: Terumi
authors.initials: T
authors.lastname: Kamisawa
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gopalakrishna
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hara
authors.forename: Taku
authors.initials: T
authors.lastname: Tabata
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Inaba
authors.forename: Naoto
authors.initials: N
authors.lastname: Egawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
mesh_terms: D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D044963:Biopsy, Fine-Needle / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002986:Clinical Trials as Topic; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008279:Magnetic Resonance Imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology; D010195:Pancreatitis / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology* / Q000503:physiopathology; D011379:Prognosis
chemical_list: D007074:Immunoglobulin G