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Lymphoplasmacytic sclerosing pancreatitis without IgG4 tissue infiltration or serum IgG4 elevation: IgG4-related disease without IgG4.

不伴IgG4组织浸润或血清IgG4升高的淋巴浆细胞硬化性胰腺炎:无IgG4的IgG4相关疾病

Hart PA,Smyrk TC,Chari ST

Abstract

Type 1 autoimmune pancreatitis can be diagnosed by and is synonymous with its pathognomonic histopathologic appearance called lymphoplasmacytic sclerosing pancreatitis. Type 1 autoimmune pancreatitis, also called IgG4-related pancreatitis, is the pancreatic manifestation of IgG4-related disease. However, the role of IgG4 in the pathogenesis of IgG4-related disease is unclear. We describe patients with LPSP without serum or tissue IgG4 abnormalities. From the Mayo Clinic database of autoimmune pancreatitis patients, we identified three patients with histologically confirmed type 1 autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis) who had normal serum IgG4 and no increase in IgG4-positive plasma cells in tissue. We reviewed original clinical records and pathologic specimens, and describe the clinical and histologic features of these three patients. All patients (age/gender: 63/F, 70/M and 68/M) had normal serum IgG and IgG4 levels, and multiple sections of pancreatic histology did not show increased IgG4-positive plasma cells. Two patients were diagnosed retrospectively following pancreatic surgery, one relapsed in another organ and one has remained relapse free. Another patient was diagnosed by pancreatic core biopsy and has suffered multiple relapses that have been controlled by rituximab. These cases highlight the fact that although the currently agreed upon name for type 1 autoimmune pancreatitis is IgG4-related pancreatitis, serum and tissue IgG4 abnormalities are best considered characteristic, but not essential for the diagnosis of this enigmatic condition.

摘要

1型自身免疫性胰腺炎也称为淋巴浆细胞硬化性胰腺炎(LPSP),后者也是该疾病的病理学特点。1型自身免疫性胰腺炎又称为IgG4相关胰腺炎,是IgG4相关疾病在胰腺的表现。然而,IgG4在IgG4相关疾病发病机制中作用尚不清楚。我们总结了梅奥诊所3例无血清或组织IgG4异常的LPSP。我们回顾了这些患者的临床资料和病理标本,并描述了这3例患者的临床和组织学特征。所有患者(年龄/性别:63/男,70/男和68/男)血清IgG和IgG4水平正常,胰腺组织多切片没有显示IgG4阳性浆细胞增加。其中两名患者是术后回顾性诊断,另外一位患者经活检诊断后多次复发,均用利妥昔单抗控制。这些病例表明,虽然目前一致认为1型自身免疫性胰腺炎是IgG4相关,血清和组织IgG4异常是其病理特点,但IgG4异常不是诊断必需。

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