Zamboni Giuseppe, Capelli Paola, Scarpa Aldo, Bogina Giuseppe, Pesci Anna, Brunello Eleonora, Klöppel Günter
Department of Pathology, University of Verona, Ospedale Sacro Cuore-Don Calabria, Via don Sempreboni 5, 37024 Negrar-Verona, Italy.
Arch Pathol Lab Med. 2009 Mar;133(3):439-53. doi: 10.5858/133.3.439.
A variety of nonneoplastic conditions may form pancreatic masses that mimic carcinoma. Approximately 5% to 10% of pancreatectomies performed with the clinical diagnosis of pancreatic cancer prove on microscopic evaluation to be pseudotumors.
To illustrate the clinical and pathologic characteristics of the 2 most frequent pseudotumoral inflammatory conditions, autoimmune pancreatitis and paraduodenal pancreatitis, and describe the criteria that may be useful in the differential diagnosis versus pancreatic carcinoma.
Recent literature and the authors' experience with the clinical and pathologic characteristics of autoimmune pancreatitis and paraduodenal pancreatitis.
The knowledge of the clinical, radiologic, and pathologic findings in both autoimmune pancreatitis and paraduodenal pancreatitis is crucial in making the correct preoperative diagnosis. Autoimmune pancreatitis, which occurs in isolated or syndromic forms, is characterized by a distinctive fibroinflammatory process that can either be limited to the pancreas or extend to the biliary tree. Its correct preoperative identification on biopsy material with ancillary immunohistochemical detection of dense immunoglobulin G4-positive plasma cell infiltration is possible and crucial to prevent major surgery and to treat these patients with steroid therapy. Paraduodenal pancreatitis is a special form of chronic pancreatitis that affects young males with a history of alcohol abuse and predominantly involves the duodenal wall in the region of the minor papilla. Pathogenetically, the anatomical and/or functional obstruction of the papilla minor, resulting from an incomplete involution of the intraduodenal dorsal pancreas, associated with alcohol abuse represents the key factor. Endoscopic drainage of the papilla minor, with decompression of the intraduodenal and dorsal pancreas, might be considered in these patients.
多种非肿瘤性疾病可形成类似癌的胰腺肿块。在临床诊断为胰腺癌而进行的胰腺切除术中，约5%至10%经显微镜评估证实为假肿瘤。
阐述两种最常见的假肿瘤性炎症疾病，即自身免疫性胰腺炎和十二指肠旁胰腺炎的临床及病理特征，并描述有助于与胰腺癌进行鉴别诊断的标准。
近期文献以及作者对自身免疫性胰腺炎和十二指肠旁胰腺炎临床及病理特征的经验。
了解自身免疫性胰腺炎和十二指肠旁胰腺炎的临床、放射学及病理表现对于做出正确的术前诊断至关重要。自身免疫性胰腺炎以孤立或综合征形式出现，其特征为独特的纤维炎症过程，可局限于胰腺或扩展至胆管树。通过活检材料及辅助免疫组化检测致密的免疫球蛋白G4阳性浆细胞浸润，有可能在术前正确识别该病，这对于避免大手术以及用类固醇疗法治疗这些患者至关重要。十二指肠旁胰腺炎是一种特殊形式的慢性胰腺炎，影响有酗酒史的年轻男性，主要累及十二指肠壁小乳头区域。从发病机制来看，十二指肠内背侧胰腺不完全退化导致小乳头的解剖和/或功能梗阻，再加上酗酒是关键因素。对于这些患者，可考虑对小乳头进行内镜引流，以减轻十二指肠内和背侧胰腺的压力。
