The similarity of Type 1 autoimmune pancreatitis to pancreatic ductal adenocarcinoma with significant IgG4-positive plasma cell infiltration

Published on Jun 1, 2013in Journal of Gastroenterology6.132
· DOI :10.1007/S00535-012-0677-X
Yuri Fukui6
Estimated H-index: 6
(Kansai Medical University),
Kazushige Uchida30
Estimated H-index: 30
(Kansai Medical University)
+ 16 AuthorsKazuichi Okazaki85
Estimated H-index: 85
(Kansai Medical University)
Background High serum immunoglobulin G4 (IgG4) levels and infiltration of IgG4-positive cells are characteristic of Type 1 autoimmune pancreatitis (AIP). We previously reported that increased regulatory T cells (Tregs) may regulate IgG4 production in AIP. Although an increased serum IgG4 concentration is observed in some patients with pancreatic ductal adenocarcinoma (PDA), clarification is still necessary. We have therefore studied the correlations between IgG4-positive cells and Tregs in patients with PDA.
📖 Papers frequently viewed together
14 Authors (Tooru Shimosegawa, ..., Lizhi Zhang)
959 Citations
2,047 Citations
1,163 Citations
#1Hisanori Umehara (Kanazawa Medical University)H-Index: 56
#2Kazuichi Okazaki (Kansai Medical University)H-Index: 85
Last. Hirotaka Ohara (Nagoya City University)H-Index: 47
view all 26 authors...
Background IgG4-related disease (IgG4-RD) is a novel clinical disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4+ plasma cells. Although IgG4-RD is not rare and is clinically important, its clinical diagnostic criteria have not been established. Comprehensive diagnostic criteria for IgG4-RD, including the involvement of various organs, are intended for the practical use of general physicians and nonspecialists.
1,174 CitationsSource
#1Takeo KusudaH-Index: 12
#2Kazushige UchidaH-Index: 30
Last. Kazuichi OkazakiH-Index: 85
view all 9 authors...
Objectives:Immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP) is a new clinical entity of pancreatic disorder. There are immunologic and histological abnormalities, including increased serum IgG4 levels and the infiltration of IgG4-positive plasmacytes. However, the role of IgG4 is uncle
55 CitationsSource
#1Tooru Shimosegawa (Tohoku University)H-Index: 95
#2Suresh T. ChariH-Index: 103
Last. Lizhi ZhangH-Index: 54
view all 14 authors...
Objectives:To achieve the goal of developing international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis (AIP).Methods:An international panel of experts met during the 14th Congress of the International Association of Pancreatology held in Fukuoka, Japan, from July 11 through 13,
959 CitationsSource
#1Johanna D Strehl (FAU: University of Erlangen-Nuremberg)H-Index: 13
#2Arndt HartmannH-Index: 105
Last. Abbas AgaimyH-Index: 59
view all 3 authors...
Background IgG4-related systemic fibrosclerosis is a recently defined disorder characterised by a diffuse or tumefactive inflammatory reaction rich in IgG4-positive plasma cells associated with sclerosis and obliterative phlebitis. Although characteristic histopathological features are essential for the diagnosis of these disorders, to date there exists no consensus regarding the cut-off values used to define a ‘significant IgG4-positive plasma cell count,’ and data regarding the distribution of...
264 CitationsSource
#1Takeshi Uehara (Shinshu University)H-Index: 26
#2Hideaki HamanoH-Index: 44
Last. Hiroyoshi OtaH-Index: 44
view all 13 authors...
Autoimmune pancreatitis (AIP) is a recently recognized disease entity. In some patients, this disease is associated with other inflammatory diseases. In this study, we aimed to elucidate the pathologic characteristics of AIP-associated gastritis (AIP-G). We evaluated and compared the pathologic findings and immunohistochemical expressions of immunoglobulin G (IgG)4 and IgG in gastric biopsy specimens from 13 AIP-G patients with those from patients of 2 control groups. We divided the AIP-G patien...
32 CitationsSource
#1Suresh T. Chari (Mayo Clinic)H-Index: 103
#2Guenter Kloeppel (Mayo Clinic)H-Index: 2
Last. Markus M. Lerch (Mayo Clinic)H-Index: 102
view all 6 authors...
Abstract Autoimmune pancreatitis (AIP) has been extensively reported from Japan, Europe, and the United States. Whereas the descriptions of AIP from Japan have predominantly been based on the presence of a distinct clinical phenotype, reports from Europe and the United States describe at least 2 histopathologic patterns in patients' condition currently diagnosed as AIP, viz, lymphoplasmacytic sclerosing pancreatitis (LPSP) and idiopathic duct centric pancreatitis (IDCP) or granulocyte epithelial...
176 CitationsSource
#1Deepti Dhall (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 3
#2Arief A. Suriawinata (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 35
Last. David S. Klimstra (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 145
view all 5 authors...
The patients with autoimmune pancreatitis usually present with jaundice and a pancreatic head mass, presumed to have pancreatic cancer, and they often undergo pancreatic resection. Elevated serum IgG4 levels (>135 mg/dL) help to distinguish autoimmune pancreatitis from pancreatic cancer. However, when the biopsy from a pancreatic mass shows dense chronic inflammation and fibrosis and the serum IgG4 level is not available, it presents a diagnostic dilemma whether it represents autoimmune pancreat...
97 CitationsSource
#1Julia T. Geyer (Harvard University)H-Index: 19
#2Judith A. FerryH-Index: 73
Last. Vikram DeshpandeH-Index: 120
view all 8 authors...
Background: Chronic sclerosing sialadenitis is a fibroinflammatory disease of the salivary glands, characteristically of the submandibular gland. One prior Asian study proposed that chronic sclerosing sialadenitis is a part of the spectrum of IgG4-associated disease. This association has not been confirmed in Western populations. We therefore, investigated the relationship between IgG4 and chronic sclerosing sialadenitis, and compared the histomorphologic features of this condition with those of...
193 CitationsSource
#1Kai Yoshizawa (Jikei University School of Medicine)H-Index: 9
#2Hiroshi Abe (Jikei University School of Medicine)H-Index: 41
Last. Yoshio Aizawa (Jikei University School of Medicine)H-Index: 15
view all 7 authors...
Aim: Regulatory T (Treg) cells may play a pivotal role in the persistence of hepatitis C virus (HCV) infection and the development of hepatocellular carcinoma (HCC). Therefore, we examined their frequency in peripheral blood from patients with HCV-positive chronic hepatitis (CH), cirrhosis (LC) and HCC. Methods: Treg cells were identified as CD4+, CD25+ and FoxP3+ T lymphocytes using three-color FACS. The frequency of Treg cells was expressed as a percentage of the total CD4+ T lymphocytes, and ...
34 CitationsSource
#1Masanori Koyabu (Kansai Medical University)H-Index: 12
#2Kazushige Uchida (Kansai Medical University)H-Index: 30
Last. Kazuichi Okazaki (Kansai Medical University)H-Index: 85
view all 12 authors...
Objectives Patients with autoimmune pancreatitis (AIP) characteristically show elevated serum levels of immunoglobulin G4 (IgG4) and abundant infiltration of IgG4-positive plasmacytes in the involved organs. The most common involved organ showing extrapancreatic lesions is the bile duct, which exhibits sclerosing cholangitis (SC). However, the role of IgG4 in the development of IgG4-related SC (IgG4-SC) remains unclear. To clarify the role of IgG4 in IgG4-SC, we have performed an immunohistochem...
73 CitationsSource
Cited By20
#1Takuya Ishikawa (Nagoya University)H-Index: 14
#2Hiroki Kawashima (Nagoya University)H-Index: 27
Last. Mitsuhiro Fujishiro (Nagoya University)H-Index: 64
view all 14 authors...
BACKGROUND AND AIM We examined the differences in the risks and characteristics of pancreatic relapse (PR) and pancreatic cancer (PC) in patients with autoimmune pancreatitis (AIP). METHODS We retrospectively reviewed 123 type 1 AIP patients with a median follow-up of 55 months (interquartile range, 27-98). The following items were evaluated: 1) cumulative relapse rates and risk factors, 2) the incidence of PC, 3) PR versus PC, and 4) outcomes after the appearance of morphological changes in the...
5 CitationsSource
#1Seung Bae Yoon (Catholic University of Korea)H-Index: 10
#2Sung-Hoon Moon (Sacred Heart Hospital)H-Index: 8
Last. Myung-Hwan Kim (UOU: University of Ulsan)H-Index: 89
view all 5 authors...
Abstract Background The diagnosis of autoimmune pancreatitis (AIP) remains challenging, especially when serum IgG4 is normal or imaging features are indeterminate. We performed a systematic review and meta-analysis to evaluate the performance of IgG4 immunostaining of pancreatic, biliary, and ampullary tissues as a diagnostic aid for AIP. Methods A comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted until February 2020. The methodological quality of ea...
3 CitationsSource
Abstract Objectives We examined the efficacy and limitations of acquiring large specimens by endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for diagnosing type 1 autoimmune pancreatitis (AIP). Methods Patients from 12 institutions with non-neoplastic diseases or pancreatic ductal adenocarcinoma (PDAC) with large EUS-FNB specimens were investigated. Slides stained with hematoxylin-eosin, elastic, IgG4, and IgG stains were evaluated. The IgG4-and IgG-positive cell numbers were counted i...
11 CitationsSource
#1Kazushige Uchida (Kansai Medical University)H-Index: 30
#2Kazuichi Okazaki (Kansai Medical University)H-Index: 85
In 1995, Yoshida and colleagues proposed the concept of “autoimmune pancreatitis” (AIP), which has recently been recognized as a new pancreatic inflammatory disease. Recent studies have suggested the existence of two subtypes of AIP: type 1, which involves immunoglobulin G4 (IgG4) and is the pancreatic manifestation of IgG4-related disease (IgG4-RD); and type 2, which is characterized by granulocytic epithelial lesions. Type 2 AIP is thought to be rare in Japan. Type 1 AIP is characterized by in...
12 CitationsSource
#1Salvatore Chirumbolo (University of Verona)H-Index: 28
#2Geir BjørklundH-Index: 32
Last. Antonio VellaH-Index: 14
view all 4 authors...
ABSTRACTBasophils are circulating cells that are associated quite exclusively with allergy response and hypersensitivity reactions but their role in the immune network might be much more intriguing and complex than previously expected. The feasibility of testing their biology in vitro for allergy research and diagnosis, due fundamentally to their quite easy availability in the peripheral blood, made them the major source for assessing allergy in the laboratory assay, when yet many further cells ...
15 CitationsSource
#1Kenichi Takano (Sapporo Medical University)H-Index: 23
#2Motohisa YamamotoH-Index: 41
Last. Tetsuo Himi (Sapporo Medical University)H-Index: 41
view all 5 authors...
2 CitationsSource
#1Yusuke KawamotoH-Index: 11
#2Yusuke OmeH-Index: 8
Last. Kazuyuki KawamotoH-Index: 8
view all 7 authors...
#1Kazuichi OkazakiH-Index: 85
#1Shin-ichiro Hiraoka (Osaka University)H-Index: 3
#2Makoto Matsukawa (Osaka University)H-Index: 1
Last. Mikihiko Kogo (Osaka University)H-Index: 31
view all 6 authors...
Abstract Immunoglobulin G4-related disease (IgG4-RD) is a chronic disease characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells into the lesions in the tissue. In the mandibulofacial region, the initial symptoms are often observed in the submandibular glands, but rarely in the labial salivary gland (LSG), which are minor salivary glands. Here, we report our experience with a case of IgG4-RD, in which the initial symptoms were observed in a LSG. The patient wa...
#1Tsukasa Ikeura (Kansai Medical University)H-Index: 19
#2Shunsuke Horitani (Kansai Medical University)H-Index: 1
Last. Kazuichi Okazaki (Kansai Medical University)H-Index: 85
view all 11 authors...
: A 63-year-old woman presented to our hospital with elevated levels of serum IgG4, marked wall thickening of the gallbladder, hepatomegaly, and abdominal lymphadenopathy. She experienced a recurrent fever and leg edema. Her laboratory data demonstrated anemia, hypoalbuminemia, and elevated serum levels of interleukin-6 and C-reactive protein. The patient was eventually diagnosed with IgG4-related disease according to the comprehensive diagnostic criteria, although the patient exhibited common c...
7 CitationsSource