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Differentiation of Autoimmune Pancreatitis from Pancreatic Cancer Remains Challenging

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Abstract

Background

Autoimmune pancreatitis (AIP) is an uncommon form of chronic pancreatitis. Whilst being corticosteroid responsive, AIP often masquerades radiologically as pancreatic neoplasia. Our aim is to appraise demographic, radiological and histological features in our cohort in order to differentiate AIP from pancreatic malignancy.

Methods

Clinical, biochemical, histological and radiological details of all AIP patients 1997–2016 were analysed. The initial imaging was re-reviewed according to international guidelines by three blinded independent radiologists to evaluate features associated with autoimmune pancreatitis and pancreatic cancer.

Results

There were a total of 45 patients: 25 in type 1 (55.5%), 14 type 2 (31.1%) and 6 AIP otherwise not specified (13.3%). The median (IQR) age was 57 (51–70) years. Thirty patients (66.6%) were male. Twenty-six patients (57.8%) had resection for suspected malignancy and one for symptomatic chronic pancreatitis. Three had histologically proven malignancy with concurrent AIP. Two patients died from recurrent pancreatic cancer following resection. Multidisciplinary team review based on radiology and clinical history dictated management. Resected patients (vs. non-resected group) were older (64 vs. 53, p = 0.003) and more frequently had co-existing autoimmune pathologies (22.2 vs. 55.6%, p = 0.022). Resected patients also presented with less classical radiological features of AIP, which are halo sign (0/25 vs. 3/17, p = 0.029) and loss of pancreatic clefts (18/25 vs. 17/17, p = 0.017). There were no differences in demographic features other than age.

Conclusion

Despite international guidelines for diagnosing AIP, differentiation from pancreatic cancer remains challenging. Resection remains an important treatment option in suspected cancer or where conservative treatment fails.

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Acknowledgements

The authors would like to thank the multitude of staff who have been involved in delivering the excellent care of patients at the Royal Liverpool University Hospital over the course of this paper. None of the authors report any conflicts of interests.

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Authors and Affiliations

  1. Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    L. D. Dickerson, R. Baron, M. Raraty, P. Ghaneh, R. Sutton, P. Whelan & V. S. Yip

  2. Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    A. Farooq, F. Bano & P. Healey

  3. Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle (Saale), Germany

    J. Kleeff

  4. Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK

    P. Ghaneh, R. Sutton & J. P. Neoptolemos

  5. Department of Pathology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    F. Campbell

  6. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    J. P. Neoptolemos

  7. Department of Hepatobiliary and Pancreas Surgery, 13C Royal London Hospital, Whitechapel Road, London, E1 1BB, UK

    V. S. Yip

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  1. L. D. Dickerson
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  2. A. Farooq
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  10. F. Campbell
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Correspondence to V. S. Yip.

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Dickerson, L.D., Farooq, A., Bano, F. et al. Differentiation of Autoimmune Pancreatitis from Pancreatic Cancer Remains Challenging. World J Surg 43, 1604–1611 (2019). https://doi.org/10.1007/s00268-019-04928-w

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