Infiltration of IgG4-positive cells in pancreatic ductal adenocarcinoma

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  • Fukui Yuri
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Uchida Kazushige
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Sumimoto Kimi
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Kusuda Takeo
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Miyoshi Hideaki
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Fukata Norimasa
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Koyabu Masanori
    Department of Internal Medicine, Kansai Medical University Kori Hospital
  • Ikeura Tsukasa
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Sakaguchi Yutaku
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Shimatani Masaaki
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Fukui Toshiro
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Matsushita Mitsunobu
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Takaoka Makoto
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Nishio Akiyoshi
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University
  • Shikata Nobuaki
    Clinical Laboratory Medicine, Kansai Medical University
  • Sakaida Noriko
    Clinical Laboratory Medicine, Kansai Medical University
  • Uemura Yoshiko
    Clinical Laboratory Medicine, Kansai Medical University
  • Satoi Sohei
    Department of Surgery, Kansai Medical University
  • Kwon A-hon
    Department of Surgery, Kansai Medical University
  • Okazaki Kazuichi
    Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University

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Other Title
  • 膵癌におけるIgG4陽性細胞について
  • スイガン ニ オケル IgG4 ヨウセイ サイボウ ニ ツイテ

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Abstract

Pancreatic enlargement, a high serum immunoglobulin G4 (IgG4) level, and infiltration of IgG4-positive cells are characteristic of Type 1 autoimmune pancreatitis (AIP). Patients with AIP sometimes present with a pancreatic focal mass, which mimics pancreatic ductal adenocarcinoma (PDA), resulting in unnecessary surgery. The high serum IgG4 level may be helpful in distinguishing Type 1 AIP from PDA. However, recently, some patients with PDA present with a high serum IgG4 level. Therefore, we performed IgG4 immunohistochemistry in PDA. The ratio of cases with >10 positive cells/hpf of IgG4-positive cells was 1/21 (5%) in the PDA area and 2/21 (10%) in the obstructive pancreatitis area, characterized by upstream dilation of the main pancreatic duct by the cancer. The ratio of cases >40% IgG4-positive cells per IgG-positive cells (IgG4/IgG) was 9/21 (43%) in the PDA area, 6/21 (29%) in the peritumoral pancreatitis area, and 3/21 (14%) in the obstructive pancreatitis area. <br/>Lately, we have come to diagnose pancreatic diseases using endoscopic ultrasound. The infiltration of IgG4-positive cells is also found in obstructive pancreatitis along with PDA. Therefore, clinicians should be very careful in making a differential diagnosis of PDA and Type 1 AIP based on the number of IgG4-positive cells and the ratio of IgG4/IgG, especially if they only have a small sample taken by endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB).

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