Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Simultaneous occurrence of autoimmune pancreatitis and pancreatic cancer in patients resected for focal pancreatic mass
Peter Macinga, Adela Pulkertova, Lukas Bajer, Jana Maluskova, Martin Oliverius, Martin Smejkal, Maria Heczkova, Julius Spicak, Tomas Hucl
Peter Macinga, Adela Pulkertova, Lukas Bajer, Julius Spicak, Tomas Hucl, Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
Jana Maluskova, Department of Pathology, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
Martin Oliverius, Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
Martin Smejkal, Department of Radiodiagnostics and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
Maria Heczkova, Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
Author contributions: Hucl T designed the research; Macinga P, Pulkertova A, Bajer L and Heczkova M performed the research; Macinga P and Hucl T analysed the data; Maluskova J and Smejkal M provided clinical advice and contributed to the analysis; Macinga P and Hucl T wrote the paper; Oliverius M and Spicak J supervised the research and revised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee with multi-center competence of the Institute for Clinical and Experimental Medicine (IKEM) and Thomayer Hospital (TN).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationship to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tomas Hucl, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Videnska 9, Prague 140 21, Czech Republic. tomas.hucl@ikem.cz
Telephone: +420-2-61362600 Fax: +420-2-61362615
Received: December 28, 2016
Peer-review started: December 29, 2016
First decision: January 10, 2017
Revised: January 31, 2017
Accepted: March 2, 2017
Article in press: March 2, 2017
Published online: March 28, 2017
AIM
To assess the occurrence of autoimmune pancreatitis (AIP) in pancreatic resections performed for focal pancreatic enlargement.
METHODS
We performed a retrospective analysis of medical records of all patients who underwent pancreatic resection for a focal pancreatic enlargement at our tertiary center from January 2000 to July 2013. The indication for surgery was suspicion of a tumor based on clinical presentation, imaging findings and laboratory evaluations. The diagnosis of AIP was based on histology findings. An experienced pathologist specialized in pancreatic disease reviewed all the cases and confirmed the diagnosis in pancreatic resection specimens suggestive of AIP. The histological diagnosis of AIP was set according to the international consensus diagnostic criteria.
RESULTS
Two hundred ninety-five pancreatic resections were performed in 201 men and 94 women. AIP was diagnosed in 15 patients (5.1%, 12 men and 3 women) based on histology of the resected specimen. Six of them had AIP type 1, nine were diagnosed with AIP type 2. Pancreatic adenocarcinoma (PC) was also present in six patients with AIP (40%), all six were men. Patients with AIP + PC were significantly older (60.5 vs 49 years of age, P = 0.045), more likely to have been recently diagnosed with diabetes (67% vs 11%, P = 0.09), and had experienced greater weight loss (15.5 kg vs 8.5 kg, P = 0.03) than AIP patients without PC. AIP was not diagnosed in any patients prior to surgery; however, the diagnostic algorithm was not fully completed in every case.
CONCLUSION
The possible co-occurrence of PC and AIP suggests that preoperative diagnosis of AIP does not rule out simultaneous presence of PC.
Core tip: In this retrospective study we confirmed that a considerable proportion of patients undergoing pancreatic resection for tumor suspicion have autoimmune pancreatitis. Furthermore, we show here the largest ever published group of patients with pancreatic cancer and autoimmune pancreatitis co-occurrence. The possible synchronous occurrence of autoimmune pancreatitis and pancreatic cancer implies major clinical consequences as the preoperative diagnosis of autoimmune pancreatitis might not rule out pancreatic cancer. Patients with autoimmune pancreatitis and patients with autoimmune pancreatitis and pancreatic cancer differed in age at presentation, presence of diabetes and the extent of weight loss.
