Uehara Takeshi, Hamano Hideaki, Kawa Shigeyuki, Kobayashi Yukihiro, Yoshizawa Akihiko, Oki Keiko, Nakata Rie, Kobayashi Akira, Sano Kenji, Ota Hiroyoshi
Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Pathol Int. 2014 Feb;64(2):51-7. doi: 10.1111/pin.12136.
Type 1 autoimmune pancreatitis (AIP-1) is an immunoglobulin G (IgG)-4-related disease (IgG4-RD), characterized by elevated serum immunoglobulin G4 (IgG4) and infiltration by IgG4(+) plasma cells. Pancreatic carcinoma (PC) sometimes shows infiltration by IgG4(+) plasma cells, but details have been unclear. We compared pathological findings and expression of IgG4 and IgG in fibroses in 18 PC patients to those from 9 AIP-1 patients. Fibroses were divided into areas of ductal adenocarcinoma (DA) and obstructive pancreatitis (OP). Serum IgG4 levels were lower than the cut-off value in all PC patients with no IgG4-RD. Diffuse lymphoplasmacytic infiltration and eosinophil infiltration were characteristic of fibroses in PC. Though AIP-1 samples often had storiform fibrosis even in biopsies, PC did not show storiform fibrosis. Ratios of IgG4(+) plasma cells/IgG(+) plasma cells (IgG4/IgG ratios) in DA and OP were significantly lower than in AIP-1. However, high-density IgG4(+) plasma cell foci were detected in PC fibroses, particularly around peripheral nerves, vessels, and lymphoid follicles; between lobules and invasion fronts; and within neutrophilic abscesses. In conclusion, the IgG4/IgG ratio is useful in distinguishing PC from AIP-1, and should be evaluated in three or more areas, as PC can show localized high-density IgG4(+) plasma cell areas.
1型自身免疫性胰腺炎（AIP-1）是一种免疫球蛋白G（IgG）-4相关性疾病（IgG4-RD），其特征为血清免疫球蛋白G4（IgG4）升高以及IgG4（+）浆细胞浸润。胰腺癌（PC）有时也会出现IgG4（+）浆细胞浸润，但具体情况尚不清楚。我们比较了18例PC患者与9例AIP-1患者纤维化组织中IgG4和IgG的病理表现及表达情况。纤维化组织分为导管腺癌（DA）区域和梗阻性胰腺炎（OP）区域。所有无IgG4-RD的PC患者血清IgG4水平均低于临界值。弥漫性淋巴细胞浆细胞浸润和嗜酸性粒细胞浸润是PC纤维化组织的特征。尽管AIP-1样本即使在活检时也常出现席纹状纤维化，但PC并未出现席纹状纤维化。DA和OP中IgG4（+）浆细胞/IgG（+）浆细胞的比例（IgG4/IgG比例）显著低于AIP-1。然而，在PC纤维化组织中检测到高密度的IgG4（+）浆细胞灶，特别是在周围神经、血管和淋巴滤泡周围；小叶间和浸润前沿；以及嗜中性脓肿内。总之，IgG4/IgG比例有助于区分PC和AIP-1，并且由于PC可出现局部高密度IgG4（+）浆细胞区域，因此应在三个或更多区域进行评估。
