Isolated intrapancreatic Ig G4-related sclerosing cholangitis

作     者：Takahiro Nakazawa Yushi Ikeda Yoshiaki Kawaguchi Hirohisa Kitagawa Hiroki Takada Yutaka Takeda Isamu Makino Naohiko Makino Itaru Naitoh Atsushi Tanaka 

作者机构：Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical SciencesNagoya 467-8601Japan Department of GastroenterologyYamagata University Faculty of MedicineYamagata 990-9585Japan Department of GastroenterologyTokai University School of MedicineKanagawa 259-1153Japan Gastroenterologic SurgeryDivision of Cancer Medicine Graduate School of Medical ScienceKanazawa UniversityKanazawa 920-8640Japan Department of Gastroenterology Kasugai Municipal HospitalKasugai 486-8510Japan Department of SurgeryKansai Rosai HospitalOsaka 660-8511Japan Department of MedicineTeikyo University School of MedicineTokyo 173-8606Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2015年第21卷第4期

页      面：1334-1343页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by Health Labor Science Research Grants from Research on Measures for Intractable Diseases the IntractableHepato-Biliary Diseases Study Group in Japan 

主　　题：Immunoglobulin G4-related sclerosing cholangitis I 

摘      要：Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is frequently associated with type 1 autoimmune pancreatitis(AIP). Association with AIP can be utilized in the diagnosis of Ig G4-SC. However, some cases of Ig G4-SC are isolated from AIP, which complicates the diagnosis. Most of the reported cases of isolated Ig G4-SC displayed hilar biliary strictures, whereas isolated Ig G4-SC with intrapancreatic biliary stricture is very rare. Recently, we have encountered 5 isolated intrapancreatic Ig G4-SC cases that were not associated with AIP, three of which were pathologically investigated after surgical operation. They all were males with a mean age of 74.2 years. The pancreas was not enlarged in any of these cases. No irregular narrowing of the main pancreatic duct was found. Bile duct wall thickening in lesions without luminal stenosis was detected by abdominal computed tomography in all five cases, by endoscopic ultrasonography in two out of four cases and by intraductal ultrasonography in all three cases. In three cases, serum Ig G4 levels were within the normal limits. The mean serum Ig G4 level measured before surgery was 202.1 mg/d L(4 cases). Isolated intrapancreatic Ig G4-SC is difficult to diagnose, especially if the Ig G4 level remains normal. Thus, this type of Ig G4-SC should be suspected in addition to cholangiocarcinoma and pancreatic cancer if stenosis of intrapancreatic bile duct is present.