Sari Ráty1, Juhani Sand2, Isto Nordback1, Irina Rinta-Kiikka3, Kaija Vasama4, Jaana Hagström5, Stig Nordling5, Jukka Sirén6, Tuula Kiviluoto6, Caj Haglund7. 1. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. 2. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland juhani.sand@pshp.fi. 3. Department of Clinical Radiology, Tampere University Hospital, Tampere, Finland. 4. Laboratory Center, Tampere University Hospital, Tampere, Finland. 5. Department of Pathology, Helsinki University Hospital, Helsinki, Finland. 6. Department of Surgery, Helsinki University Hospital, Helsinki, Finland. 7. Department of Surgery, Helsinki University Hospital, Helsinki, Finland Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland.
Abstract
BACKGROUND: Distinguishing between pancreatic cancer and chronic pancreatitis (CP) is often difficult. Certain (5-6%) CP cases are autoimmune in nature, and these patients respond to corticosteroid treatment, making surgery avoidable. Our aim was to evaluate the incidence of autoimmune pancreatitis (AIP) among patients operated on for a pancreatic mass with a final histology of CP. PATIENTS AND METHODS: A total of 33 patients were operated on at the Tampere or Helsinki University Hospital for suspicion of cancer, but with final histopathological diagnosis of CP. The median age was 58 (31-81) years; 26 patients (79%) were male. There were 28 pancreaticoduodenectomes and five left pancreatic resections. Surgical specimens were re-evaluated by experienced pathologists, with representative samples chosen for immunohistochemistry Each sample was scored as positive or negative for immunoglobulin G4 (IgG4) independently by two pathologists. Honolulu consensus criteria served for AIP sub-typing. RESULTS: Out of the 33 specimens, 10 (30%) were positive for IgG4. Histopathological re-evaluation of these revealed all to be type 1 AIP. CONCLUSION: The proportion of AIP, according to IgG4-positive immunohistochemistry and histological re-evaluation, was much higher than expected. This suggests that by focusing on diagnosis of AIP preoperatively, certain patients might be treated with corticosteroids and possibly avoid unnecessary surgery. Copyright
BACKGROUND: Distinguishing between pancreatic cancer and chronic pancreatitis (CP) is often difficult. Certain (5-6%) CP cases are autoimmune in nature, and these patients respond to corticosteroid treatment, making surgery avoidable. Our aim was to evaluate the incidence of autoimmune pancreatitis (AIP) among patients operated on for a pancreatic mass with a final histology of CP. PATIENTS AND METHODS: A total of 33 patients were operated on at the Tampere or Helsinki University Hospital for suspicion of cancer, but with final histopathological diagnosis of CP. The median age was 58 (31-81) years; 26 patients (79%) were male. There were 28 pancreaticoduodenectomes and five left pancreatic resections. Surgical specimens were re-evaluated by experienced pathologists, with representative samples chosen for immunohistochemistry Each sample was scored as positive or negative for immunoglobulin G4 (IgG4) independently by two pathologists. Honolulu consensus criteria served for AIP sub-typing. RESULTS: Out of the 33 specimens, 10 (30%) were positive for IgG4. Histopathological re-evaluation of these revealed all to be type 1 AIP. CONCLUSION: The proportion of AIP, according to IgG4-positive immunohistochemistry and histological re-evaluation, was much higher than expected. This suggests that by focusing on diagnosis of AIP preoperatively, certain patients might be treated with corticosteroids and possibly avoid unnecessary surgery. Copyright
Authors: L D Dickerson; A Farooq; F Bano; J Kleeff; R Baron; M Raraty; P Ghaneh; R Sutton; P Whelan; F Campbell; P Healey; J P Neoptolemos; V S Yip Journal: World J Surg Date: 2019-06 Impact factor: 3.352