Díte P, Uvírová M, Bojková M, Novotný I, Dvorácková J, Kianicka B, Nechutová H, Dovrtelová L, Floreánová K, Martínek A
Academic Centre of Gastroenterology Department of Internal Medicine, University Hospital and Faculty of Medicine of the University of Ostrava, Ostrava -
Minerva Gastroenterol Dietol. 2014 Dec;60(4):247-53. Epub 2014 Oct 7.
Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer can be very difficult. The main clinical symptoms in patients with autoimmune pancreatitis are jaundice, weight loss, abdominal pain and new onset of diabetes mellitus. Unfortunately, the same symptoms could be observed in patients with pancreatic carcinoma too. Imaging methods as computed tomography (CT) scan, magnetic resonance imaging (MRI) and endosonography (EUS); together with serological examination (IgG4 and Ca 19-9) play the important role in differentiation autoimmune pancreatitis from pancreatic cancer. Extrapancreatic findings are distinctive in patients with autoimmune pancreatitis. In some cases the pancreatic biopsy is indicated, mainly in patients with focal or multifocal form of autoimmune pancreatitis. Response to steroids (decreased pancreatic or extrapancreatic lesion or damage) is distinctive to AIP. In clinical practice, CT scan seems to be the most reasonable tool for examining the patients with obstructive jaundice with or without present pancreatic mass. Stratification the patients with possible AIP versus pancreatic cancer is important. In patients with AIP it may avoid pancreatic resection, as well as incorrect steroid treatment in patients with pancreatic carcinoma.
自身免疫性胰腺炎（AIP）与胰腺癌之间的鉴别诊断可能非常困难。自身免疫性胰腺炎患者的主要临床症状为黄疸、体重减轻、腹痛以及新发糖尿病。不幸的是，胰腺癌患者也可能出现相同症状。诸如计算机断层扫描（CT）、磁共振成像（MRI）和内镜超声检查（EUS）等影像学方法，以及血清学检查（IgG4和Ca 19-9）在鉴别自身免疫性胰腺炎和胰腺癌方面发挥着重要作用。自身免疫性胰腺炎患者存在胰腺外表现。在某些情况下，主要是针对局灶性或多灶性自身免疫性胰腺炎患者，需要进行胰腺活检。对类固醇的反应（胰腺或胰腺外病变或损伤减轻）是AIP的特征。在临床实践中，CT扫描似乎是检查有无胰腺肿块的梗阻性黄疸患者的最合理工具。区分可能患有AIP的患者与胰腺癌患者很重要。对于AIP患者，这可以避免胰腺切除术，对于胰腺癌患者，也可避免不恰当的类固醇治疗。
