Clinical Features and Misdiagnosed Causes of 37 Patients with Autoimmune Pancreatitis

WANG Tian-long; ZHANG Qi; WANG Ya-wei; WU Gang

doi:10.3969/j.issn.1002-3429.2017.10.017

Abstract：Objective To investigate clinical features, differential diagnosis and misdiagnosed causes of autoimmune pancreatitis ( AIP) in order to improve the clinician 's understanding and avoid misdiagnosis and mistreatment. Methods Clinical data of 37 AIP patients admitted between February 2010 and October 2016 was retrospectively analyzed. Results The main manifestations of 37 patients (9 misdiagnosed patients) were progressive skin or sclera icterus accompanied by upper abdomen discomfort. Imaging showed that 30 patients had diffuse enlargement of pancreas and diffuse irregular narrowing of pancreatic duct, and 7 patients had focal caput pancreatis enlargement accompanied by narrowing of pancreatic duct in caput pancreatis. Stenosis of common bile duct located in pancreas was found in all patients. There were 13 patients with other auto-immune diseases besides AIP and 20 patients with other organs involvement besides pancreas. Serum immunoglobulin G ( IgG4 orγ-globulin) and autoimmunity antibody detections were performed for 24 patients, in whom20 patients had increased expres-sion of serumIgG4 or γ-globulin, and 11 patients had positive autoimmune antibodies. Pathology and immunohistochemistry tests for 10 patients with other organ lesions showed massive lymphocytes and IgG4 ( +) plasmacytes infiltration. Corticoste-roid hormone treatment was performed for 28 patients, in whom 6 patients recurred and were cured after continuous hormone therapy. Surgery treatment was performed for 9 patients (24. 3%) misdiagnosed as having pancreatic cancer, in whom 8 pa-tients underwent cholangiojejunostomy and 1 patient underwent pancreatoduodenectomy, and then AIP was confirmed on the basis of results of postoperative pathology and imaging of pancreas, and there was no recurrence during 2 years of follow-up. Conclusion Clinical features of AIP is similar to those of pancreatic cancer, and therefore it is easy to be misdiagnosed. It is helpful to distinguish AIP from pancreatic cancer by performing serum immunological test in time and experimental hormone therapy if necessary.