Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
Pancreatology. 2013 Jul-Aug;13(4):379-83. doi: 10.1016/j.pan.2013.04.197. Epub 2013 Apr 26.
BACKGROUND/AIMS: Coexistence of autoimmune pancreatitis (AIP) and pancreatic cancer, elevation of serum IgG4 levels in pancreatic cancer patients, and infiltration of IgG4-positive plasma cells in peritumorous pancreatitis have been described in a few reports. This study examined the relationship between intraductal papillary mucinous neoplasm (IPMN) of the pancreas and peritumorous IgG4-positive lymphoplasmacytic infiltrates.
Serum IgG4 levels were measured in 54 patients with IPMN (median 70 years, 26 males and 28 females; 13 main duct type and 41 branch duct type). Histological findings focusing on dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis were reviewed, and immunostaining with IgG4 and IgG was performed in 23 surgically resected IPMN cases (18 main duct type and 5 branch duct type). The presence of IgG4-positive plasma cells >10/hpf and an IgG4-positive/IgG-positive plasma cell ratio >40% were considered significant.
Serum IgG4 levels were elevated in 2 (4%) IPMN patients. Significant infiltration of IgG4-positive plasma cells was detected in 4 IPMN cases (17%). The IgG4-positive/IgG-positive plasma cell ratio was >40% in all 4 cases. In one case with a markedly elevated serum IgG4 level (624 mg/dL), typical lymphoplasmacytic sclerosing pancreatitis (AIP type 1) lesions surrounded the whole IPMN. In the 3 other cases, infiltration of IgG4-positive plasma cells with fibrosis was focally detected mainly in the periductal area around the IPMN.
In a few patients with IPMNs, IgG4-positive plasma cell infiltration can occur in the peritumorous area. The association of an IPMN with AIP type 1-like changes seems to be exceptional and coincidental.
背景/目的：少数报道描述了自身免疫性胰腺炎（AIP）和胰腺癌共存、胰腺癌患者血清 IgG4 水平升高以及肿瘤周围胰腺炎中 IgG4 阳性浆细胞浸润。本研究检查了胰腺内导管乳头状黏液性肿瘤（IPMN）与肿瘤周围 IgG4 阳性淋巴浆细胞浸润之间的关系。
对 54 例 IPMN 患者（中位年龄 70 岁，26 例男性和 28 例女性；13 例主胰管型和 41 例分支胰管型）测量血清 IgG4 水平。回顾性观察致密淋巴浆细胞浸润、席纹状纤维化和闭塞性静脉炎等组织学发现，并对 23 例手术切除的 IPMN 病例（18 例主胰管型和 5 例分支胰管型）进行 IgG4 和 IgG 免疫染色。>10/hpf 的 IgG4 阳性浆细胞和 IgG4 阳性/IgG 阳性浆细胞比值>40%被认为有意义。
2（4%）例 IPMN 患者血清 IgG4 水平升高。4 例 IPMN 患者检测到明显的 IgG4 阳性浆细胞浸润（17%）。所有 4 例的 IgG4 阳性/IgG 阳性浆细胞比值>40%。在 1 例血清 IgG4 水平明显升高（624mg/dL）的患者中，典型的淋巴浆细胞硬化性胰腺炎（AIP 1 型）病变环绕整个 IPMN。在另外 3 例中，主要在 IPMN 周围的胰管周围区域发现 IgG4 阳性浆细胞浸润伴纤维化。
在少数 IPMN 患者中，肿瘤周围区域可发生 IgG4 阳性浆细胞浸润。IPMN 与 AIP 1 型样改变的关联似乎是例外和偶然的。
