| BackgroundAutoimmune pancreatitis(AIP)is a rarely chronic fibroinflammatory disease of the pancreas which is autoimmune mediated and typically presents with obstructive jaundice and mild abdominal pain and often responds to steroid or other immunosuppressant therapy.AIP is now clearly divided into type 1 and type 2 subtypes based on clinical manifestations,serological indicators and histology.Type 1 AIP is associated with histological pattern of lymphoplasmacytic sclerosing pancreatitis(LPSP),which is now recognized as a pancreatic manifestation of IgG4-related systematic diseases especially in Asian populations and is often accompanied with some extrapancreatic lesions,such as bile ducts,salivary glands,kidneys,and lungs.Type 2 AIP is characterized by idiopathic duct-centric pancreatitis(IDCP),which is a pancreas specific disease.According to the international consensus diagnostic criteria(ICDC),which can be diagnosed using a combination of pancreatic parenchymal and duct imaging,serum IgG4 concentration,histopathological,in conjunction with other organ involvement,as well of responsiveness to steroid treatment.Autoimmune pancreatitis and pancreatic cancer(PC)can mimic each other clinically and radiologically.Misdiagnosis is often reported in the clinic,resulting in unnecessary surgery and causing huge trauma to patients.Due to the low incidence of AIP,most of reports in China are case analysis,and there are few related reports comparing with the clinical characteristics of pancreatic cancer.ObjectiveThrough retrospective analysis of the clinical data of 27 patients with autoimmune pancreatitis and 40 patients with pancreatic cancer treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to October 2019 and compare clinical characteristics between AIP and PC to summarize the clinical characteristics of AIP,improve clinicians awareness of AIP and the ability to distinguish it from PC.Method27 patients of AIP admitted in our hospital from January 2013 to October 2019 and 40 patients of PC admitted during the same period were randomly selected as the control group.The patient's general data,clinical manifestations,laboratory indicators,imaging,pathology,treatment were retrospectively analyzed.Result1.General condition:There were 27 patients with AIP,including 25 males and 2 females.The ratio of male to female was 12.5:1,age ranged from 32 to 78 years,and the average age was 55.78 ± 12.11 years.There were 40 patients in the PC group,including 27 males and 13 females.The ratio of male to female was 2.07:1,age ranged from 31 to 88 years,with an average age of 57.95±10.46 years.Compared with the PC group,AIP occurred more frequently in males,there was a statistically significant difference in gender between the two groups(P<0.05),but there was no statistically significant difference in age(P>0.05).There was also no significant difference in smoking history and drinking history between the two groups(P>0.05).2.Clinical manifestations:The most common symptoms of AIP patients are jaundice,abdominal pain and weight loss,with the frequency of 55.56%(15/27),33.33%(9/27),and 18.52%(5/27).The most common symptoms of PC patients are abdominal pain,jaundice,and weight loss,with frequency of 72.50%(29/40),27.50%(11/40),and 15.00%(6/40).However,abdominal pain is more common in patients with pancreatic cancer,and jaundice is more common in patients with AIP.The difference is statistically significant(P<0.05),There was no significant difference in weight loss between the two groups(P>0.05).There was no significant difference in the number of patients with hypertension,diabetes,and coronary heart disease between the two groups(P>0.05).Other organ involvement was detected in 44.44%(12 cases)of patients with AIP,including 6 cases of lymphadenopathy,2 cases of proximal bile duct stricture,and 2 cases of salivary adenitis(1 case of submandibular gland,1 case of labial gland),1 case of retroperitoneal fibrosis,1 case of gastric and duodenal involvement.3.Laboratory indicators:AIP is characterized by elevated IgG4,which is significantly higher in globulin,eosinophils,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,glutamyl transpeptidase,and total bilirubin than those in the pancreatic cancer group(P<0.05),but the levels of CA19-9 and CA125 were significantly lower than those in the pancreatic cancer group(P<0.05).4.Imaging:On CT imaging,diffuse enlargement of the pancreas,thickening of the common bile duct wall or lower narrowing and capsule-like rim were observed more frequently in AIP group than pancreatic cancer group,while focal enlargement of the pancreas,invasion of blood vessels and enlargement of multiple lymph nodes often suggested pancreatic cancel(P<0.05),There was no statistically significant difference in pancreatic duct irregular stenosis or dilation between the two groups(P>0.05).5.Pathology:AIP is characterized by the infiltration of tissues with lymphocytes,plasma cell infiltration,along with increased IgG4/IgG ratio,and interstitial fibrosis.PC is based on the discovery of tumor cells.6.Treatment:Glucocorticoid is the first choice for AIP.13.33%of patients relapse within 2 years.Patients with pancreatic cancer undergo radical surgery and postoperative adjuvant chemotherapy or palliative surgery,chemotherapy based on the severity of the disease.Conclusion1.AIP patients and PC patients are prone to affect middle-aged and elderly people.AIP is more likely to occur in men than PC patients.The main clinical manifestations are jaundice and involvement of orther organs,2.The elevation of IgG4 is a characteristic of AIP.Hepatic dysfunction is more common than PC,and PC is mainly elevated by CA19-9 and CA125 levels.3.Diffuse enlargement of the pancreas,thickening of the common bile duct wall/lower narrowing and capsule-like rim were observed more frequently in AIP group than pancreatic cancer group,while focal enlargement of the pancreas,invasion of blood vessels and enlargement of multiple lymph nodes often suggested pancreatic cancer.4.The histology of AIP and PC is significantly different.When the differential diagnosis between the two is difficult,pancreatic biopsy can be useful.Oral glucocorticoid is the main treatment for AIP,pancreatic cancer is based on a variety of factors to develop an individualized treatment plan. |
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