Shimamura Naruki, Takano Shinichi, Fukasawa Mitsuharu, Kadokura Makoto, Shindo Hiroko, Takahashi Ei, Hirose Sumio, Fukasawa Yoshimitsu, Kawakami Satoshi, Hayakawa Hiroshi, Kuratomi Natsuhiko, Hasegawa Hiroyuki, Harai Shota, Yoshimura Dai, Imagawa Naoto, Yamaguchi Tatsuya, Inoue Taisuke, Maekawa Shinya, Sato Tadashi, Enomoto Nobuyuki
First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan.
Department of Gastroenterology, Kofu Municipal Hospital, 366, Masutsubo, Kofu 400-0832, Yamanashi, Japan.
J Clin Med. 2022 Jul 19;11(14):4189. doi: 10.3390/jcm11144189.
The diagnosis of autoimmune pancreatitis (AIP) and immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) may require a somewhat invasive pathological examination and steroid responsiveness. This retrospective study assessed the complemental diagnosis of AIP and IgG4-SC using submandibular gland (SG) ultrasonography (US) in 69 patients, including 54 patients with AIP, 2 patients with IgG4-SC, and 13 patients with both AIP and IgG4-SC. The data from the physical examination and US of SGs to diagnose AIP ( = 67) and IgG4-SC ( = 15) were analyzed. The steroid therapy efficacy in resolving hypoechoic lesions in SGs was evaluated in 36 cases. The presence of IgG4-related pancreaticobiliary disease with multiple hypoechoic lesions in SGs was reduced from 31 to 11 cases after steroid therapy, suggesting that multiple hypoechoic lesions in SGs are strongly associated with IgG4-positive cell infiltrations. Multiple hypoechoic lesions in SGs were observed in 53 cases, whereas submandibular swelling on palpation was observed in 21 cases of IgG4-related pancreaticobiliary diseases. A complemental diagnosis of IgG4-related pancreaticobiliary diseases without a histological diagnosis and steroid therapy was achieved in 57 and 68 cases without and with multiple hypoechoic lesions in SGs, respectively. In conclusion, multiple hypoechoic lesions in SGs are useful for the complemental diagnosis of IgG4-related pancreaticobiliary diseases.
自身免疫性胰腺炎（AIP）和免疫球蛋白G4相关性硬化性胆管炎（IgG4-SC）的诊断可能需要某种程度的侵入性病理检查以及激素反应性评估。本回顾性研究评估了69例患者的颌下腺（SG）超声检查（US）对AIP和IgG4-SC的辅助诊断价值，其中包括54例AIP患者、2例IgG4-SC患者以及13例同时患有AIP和IgG4-SC的患者。分析了用于诊断AIP（n = 67）和IgG4-SC（n = 15）的体格检查和SG超声检查数据。对36例患者评估了激素治疗对SG低回声病变的疗效。激素治疗后，SG出现多个低回声病变的IgG4相关性胰胆管疾病患者数量从31例减少至11例，这表明SG中的多个低回声病变与IgG4阳性细胞浸润密切相关。53例患者观察到SG有多个低回声病变，而在21例IgG4相关性胰胆管疾病患者中触诊发现颌下肿胀。在SG无多个低回声病变和有多个低回声病变的患者中，分别有57例和68例在未进行组织学诊断和激素治疗的情况下实现了对IgG4相关性胰胆管疾病的辅助诊断。总之，SG中的多个低回声病变对IgG4相关性胰胆管疾病的辅助诊断有用。
