Autoimmune Pancreatitis and Treatment Approaches with Case Reports

Abstract

Objective: In this study, we aimed to review retrospectively the data of 10 patient who were treated and followed-up in our clinic and to review the current approaches in the diagnosis and treatment of autoimmune pancreatitis (AIP). Material and Methods: We reviewed 10 patients retrospectively who were operated on and had the diagnosis of AIP histopathologically in the Ege University School of Medicine Department of General Surgery. Results: Between June 2001-November 2010, 10 patients who were diagnosed as AIP were examined retrospectively. Radiologically, a pancreatic mass was found in the pancreatic head with ultrasound in 7 (70%) of 10 patients and suspicious lesions were identified in the head of the pancreas in 3 (30%) patients. All patients were operated on in our clinic with the preliminary diagnosis of pancreatic head tumor; 8 patients underwent Whipple's procedure, 1 patient underwent pylorus preserving pancreaticoduodenectomy, and in 1 patient an exploratory pancreatic biopsy (frozen section) was carried out. Conclusion: Autoimmune pancreatitis is a disease with increasing incidence and characterized by lymphoplasmocytic cell infiltration and fibrosis. Patients with a pancreatic mass, if there is an autoimmune disease or chronic pancreatitis suspected in the detailed history, it is necessary to evaluate patients in terms of AIP serologically to protect the patients from an incoorectng diagnosis and morbidity of surgery. Turkish Başlık: Otoimmun Pankreatit ve Olgu Sunumlarıyla Tedaviye Yaklaşım Amaç: Bu çalışmada, kliniğimizde takip ve tedavi edilen 10 otoimmun pankretit (OİP) olgusunu inceleyerek hastalığın güncel tanı yöntemlerini ve tedavi yaklaşımlarını değerlendirmeyi amaçladık. Hastalar ve Yöntemler: Ege Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalında Haziran 2001 ile Kasım 2010 tarihleri arasında ameliyat edilen ve OİP tanısı alan 10 hasta geriye dönük olarak incelendi. Tanı histopatolojik incelemeyle doğrulandı. Sonuçlar: Radyolojik olarak yapılan tetkiklerde ultrason ile 10 hastanın 7'sinde (%70) pankreas başında kitle bulundu, hastalardan 3'ünde (%30) ise pankreas başında şüpheli lezyon saptandı. Kliniğimizde ameliyata alınan hastaların tümünün ön tanıları pankreas başı tümörüydü; 8 hastaya Whipple prosedürü, 1 hastaya piloru koruyucu pankreatikoduodenektomi ve bir hastaya da eksplorasyon ile pankreas biopsisi (frozen section ) uygulandı. Tartışma: OİP lenfoplazmositer hücre infiltrasyonu ve fibrozisle karakterize olan ve giderek artan sıklıkta görülen bir hastalıktır. Eğer pankreasta kitle ile gelen hastanın öyküsünde otoimmun hastalık şüphesi veya kronik pankreatit öyküsü varsa bu tür olgular yanlış tanı ve cerrahi morbiditeyi önlemek için serolojik olarak OİP yönünden değerlendirilmelidir.

Keywords

• Autoimmune pancreatitis, diagnosis, treatment approaches

Autoimmune Pancreatitis and Treatment Approaches with Case Reports

Öz

Kaynakça

1. Sarles H, Sarles JC, Muratore R. Chronic inflammatory sclerosis of the pancreas-an autoimmune pancreatic disease? Am J Dig Dis 1961;6:688-98. [CrossRef]
2. Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality: proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995;40:1561-8. [CrossRef]
3. Fan BG, Sandberg AA. Autoimmune pancreatitis. North Am J Med Sci 2009;1:148-51.
4. Nishimori I, Tamakoshi A, Otsuki M. Research Committee on In- tractable Diseases of the Pancreas, Ministry of Health, Labour, and Welfare of Japan. Prevalence of autoimmune pancreati- tis in Japan from a nationwide survey in 2002. J Gastroenterol 2007;18:6-8. [CrossRef]
5. Okazaki K, Uchida K, Fukui T, Takaoka M, Nishio A. Autoimmune pancreatitis--a new evolving pancreatic disease? Langenbecks Arch Surg 2010;395:989-1000. [CrossRef]
6. Morselli-Labate AM, Pezzilli R. Usefulness of serum IgG4 in the diagnosis and follow up of autoimmune pancreatitis: A system- atic literature review and meta-analysis. J Gastroenterol Hepatol 2009;24:15-36. [CrossRef]
7. Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, Nishimori I, et al. Research Committee of Intractable Diseases of the Pan- creas. Clinical diagnostic criteria of autoimmune pancreatitis: re- vised proposal. J Gastroenterol 2006;41:626-31. [CrossRef]
8. Sahel J, Barthet M, Gasmi M. Autoimmune pancreatitis: increas- ing evidence for a clinical entity with various patterns. Eur J Gas- troenterol Hepatol 2004;16:1265-8. [CrossRef]

9. Finkelberg DL, Sahani D, Deshpande V, Brugge WR. Autoim- mune pancreatitis. N Engl J Med 2006;355:2670-6. [CrossRef] 433
10. ; 29: 431-3 Ünalp et al.
11. Autoimmune Pancreatitis and Treatment