Isolated intrapancreatic Ig G4-related sclerosing cholangitis
Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is frequently associated with type 1 autoimmune pancreatitis(AIP). Association with AIP can be utilized in the diagnosis of Ig G4-SC. However, some cases of Ig G4-SC are isolated from AIP, which complicates the diagnosis. Most of the reporte...
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| Published in: | 世界胃肠病学杂志：英文版 no. 4; pp. 1334 - 1343 |
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| Main Author: | |
| Format: | Journal Article |
| Language: | English |
| Published: |
2015
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is frequently associated with type 1 autoimmune pancreatitis(AIP). Association with AIP can be utilized in the diagnosis of Ig G4-SC. However, some cases of Ig G4-SC are isolated from AIP, which complicates the diagnosis. Most of the reported cases of isolated Ig G4-SC displayed hilar biliary strictures, whereas isolated Ig G4-SC with intrapancreatic biliary stricture is very rare. Recently, we have encountered 5 isolated intrapancreatic Ig G4-SC cases that were not associated with AIP, three of which were pathologically investigated after surgical operation. They all were males with a mean age of 74.2 years. The pancreas was not enlarged in any of these cases. No irregular narrowing of the main pancreatic duct was found. Bile duct wall thickening in lesions without luminal stenosis was detected by abdominal computed tomography in all five cases, by endoscopic ultrasonography in two out of four cases and by intraductal ultrasonography in all three cases. In three cases, serum Ig G4 levels were within the normal limits. The mean serum Ig G4 level measured before surgery was 202.1 mg/d L(4 cases). Isolated intrapancreatic Ig G4-SC is difficult to diagnose, especially if the Ig G4 level remains normal. Thus, this type of Ig G4-SC should be suspected in addition to cholangiocarcinoma and pancreatic cancer if stenosis of intrapancreatic bile duct is present. |
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| Bibliography: | Immunoglobulin G4-related sclerosing cholangitis;I Takahiro Nakazawa;Yushi Ikeda;Yoshiaki Kawaguchi;Hirohisa Kitagawa;Hiroki Takada;Yutaka Takeda;Isamu Makino;Naohiko Makino;Itaru Naitoh;Atsushi Tanaka;Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences,Nagoya 467-8601,Japan;Department of Gastroenterology,Yamagata University Faculty of Medicine,Yamagata 990-9585,Japan;Department of Gastroenterology,Tokai University School of Medicine,Kanagawa 259-1153,Japan;Gastroenterologic Surgery,Division of Cancer Medicine, Graduate School of Medical Science,Kanazawa University,Kanazawa 920-8640,Japan;Department of Gastroenterology, Kasugai Municipal Hospital,Kasugai 486-8510,Japan;Department of Surgery,Kansai Rosai Hospital,Osaka 660-8511,Japan;Department of Medicine,Teikyo University School of Medicine,Tokyo 173-8606,Japan Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is frequently associated with type 1 autoimmune pancreatitis(AIP). Association with AIP can be utilized in the diagnosis of Ig G4-SC. However, some cases of Ig G4-SC are isolated from AIP, which complicates the diagnosis. Most of the reported cases of isolated Ig G4-SC displayed hilar biliary strictures, whereas isolated Ig G4-SC with intrapancreatic biliary stricture is very rare. Recently, we have encountered 5 isolated intrapancreatic Ig G4-SC cases that were not associated with AIP, three of which were pathologically investigated after surgical operation. They all were males with a mean age of 74.2 years. The pancreas was not enlarged in any of these cases. No irregular narrowing of the main pancreatic duct was found. Bile duct wall thickening in lesions without luminal stenosis was detected by abdominal computed tomography in all five cases, by endoscopic ultrasonography in two out of four cases and by intraductal ultrasonography in all three cases. In three cases, serum Ig G4 levels were within the normal limits. The mean serum Ig G4 level measured before surgery was 202.1 mg/d L(4 cases). Isolated intrapancreatic Ig G4-SC is difficult to diagnose, especially if the Ig G4 level remains normal. Thus, this type of Ig G4-SC should be suspected in addition to cholangiocarcinoma and pancreatic cancer if stenosis of intrapancreatic bile duct is present. |
| ISSN: | 1007-9327 2219-2840 |