Hedayat Amin A, Lisovsky Mikhail, Suriawinata Arief A, Longnecker Daniel S
Department of Pathology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, United States.
Department of Pathology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, United States.
Pancreatology. 2017 Mar-Apr;17(2):263-266. doi: 10.1016/j.pan.2017.02.004. Epub 2017 Feb 8.
Concurrent intraductal papillary-mucinous neoplasm (IPMN) and autoimmune pancreatitis (AIP) was observed in a patient (index case) at our institution. Cases of coincidental IPMN and type 1 AIP and concurrent ductal adenocarcinoma (PDAC) and AIP have been previously reported. In this study we evaluate the hypothesis that IPMN elicits an IgG4 response.
Twenty-one pancreases (including the index case) with IPMN resected at our institution were studied. H&E stained slides were reviewed and blocks of peritumoral pancreas were immunostained with IgG4 to look for IgG4-positive plasma cells.
We found evidence of variable IgG4 overexpression in 4/21 (19%) of IPMN. These included the index case and three others without stigmata of AIP.
A small subset of pancreatic neoplasms including intraductal papillary-mucinous neoplasms (IPMN) is associated with an IgG4 autoimmune response that sometimes progresses to peritumoral type 1 AIP and less often to diffuse AIP and IgG4-related systemic disease.
在我们机构的一名患者（索引病例）中观察到同时存在导管内乳头状黏液性肿瘤（IPMN）和自身免疫性胰腺炎（AIP）。此前已有IPMN与1型AIP并存以及导管腺癌（PDAC）与AIP并存的病例报道。在本研究中，我们评估IPMN引发IgG4反应这一假说。
对在我们机构切除的21例伴有IPMN的胰腺（包括索引病例）进行研究。复查苏木精-伊红（H&E）染色切片，并用IgG4对肿瘤周围胰腺组织块进行免疫染色，以寻找IgG4阳性浆细胞。
我们在21例IPMN中的4例（19%）发现了IgG4表达可变的证据。这些病例包括索引病例以及另外3例无AIP特征的病例。
一小部分胰腺肿瘤，包括导管内乳头状黏液性肿瘤（IPMN），与IgG4自身免疫反应相关，这种反应有时会进展为肿瘤周围1型AIP，较少进展为弥漫性AIP和IgG4相关的系统性疾病。
