膵癌におけるIgG4陽性細胞について

福井 由理; 内田 一茂; 住本 貴美; 楠田 武生; 三好 秀明; 深田 憲将; 小藪 雅紀; 池浦 司; 坂口 雄沢; 島谷 昌明; 福井 寿朗; 松下 光伸; 高岡 亮; 西尾 彰功; 四方 伸明; 坂井田 紀子; 植村 芳子; 里井 壮平; 權 雅憲; 岡崎 和一

doi:10.5361/jkmu.65.19

Infiltration of IgG4-positive cells in pancreatic ductal adenocarcinoma

Yuri Fukui, Kazushige Uchida, Kimi Sumimoto, Takeo Kusuda, Hideaki Miyoshi, Norimasa Fukata, Masanori Koyabu, Tsukasa Ikeura, Yutaku Sakaguchi, Masaaki Shimatani, Toshiro Fukui, Mitsunobu Matsushita, Makoto Takaoka, Akiyoshi Nishio, Nobuaki Shikata, Noriko Sakaida, Yoshiko Uemura, Sohei Satoi, A-hon Kwon, Kazuichi Okazaki

Author information

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

Keywords: Pancreatic ductal adenocarcinoma, Autoimmune pancreatitis, IgG4

JOURNAL FREE ACCESS

2014 Volume 65 Pages 19-24

DOI https://doi.org/10.5361/jkmu.65.19

Details

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.
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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