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Journal of Gastroenterology
Published in: Journal of Gastroenterology 6/2013

01-06-2013 | Original Article—Liver, Pancreas, and Biliary Tract

The similarity of Type 1 autoimmune pancreatitis to pancreatic ductal adenocarcinoma with significant IgG4-positive plasma cell infiltration

Authors: Yuri Fukui, Kazushige Uchida, Kimi Sumimoto, Takeo Kusuda, Hideaki Miyoshi, Masanori Koyabu, Tsukasa Ikeura, Yutaku Sakaguchi, Masaaki Shimatani, Toshiro Fukui, Mitsunobu Matsushita, Makoto Takaoka, Akiyoshi Nishio, Nobuaki Shikata, Noriko Sakaida, Yoshiko Uemura, Sohei Satoi, A-hon Kwon, Kazuichi Okazaki

Published in: Journal of Gastroenterology | Issue 6/2013

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Abstract

Background

High serum immunoglobulin G4 (IgG4) levels and infiltration of IgG4-positive cells are characteristic of Type 1 autoimmune pancreatitis (AIP). We previously reported that increased regulatory T cells (Tregs) may regulate IgG4 production in AIP. Although an increased serum IgG4 concentration is observed in some patients with pancreatic ductal adenocarcinoma (PDA), clarification is still necessary. We have therefore studied the correlations between IgG4-positive cells and Tregs in patients with PDA.

Subjects and methods

A total of 21 PDA and nine AIP patients were enrolled in our study. The numbers and ratios of Tregs, IgG4-positive, and IgG-positive cells immunohistochemically stained with anti-Foxp3, IgG4, and IgG antibodies, respectively, were counted in three areas of resected pancreata in PDA, peritumoral pancreatitis (PT), and obstructive pancreatitis (OP).

Results

In PDA, PT, OP area, the number of IgG4-Positive cells (5.183 ± 1.061, 2.250 ± 0.431, 4.033 ± 1.018, respectively; p < 0.05) and the ratio of IgG4/IgG (0.391 ± 0.045, 0.259 ± 0.054, 0.210 ± 0.048, respectively; p < 0.05) were significantly lower than those in AIP (21.667 ± 2.436 and 0.306 ± 0.052, respectively). The numbers of IgG4-positive cells did not differ significantly among the three areas of resected pancreata examined. However, the IgG4/IgG (0.391 ± 0.045) and Foxp3/monocyte (0.051 ± 0.008) ratios in PDA area were significantly (p < 0.05) higher than those in OP area (IgG4/IgG: 0.210 ± 0.048; oxp3/monocyte: 0.0332 ± 0.005), but not in PT area. Of the 21 cases of PDA, the ratio of IgG4/IgG was >40 % in nine (43 %), six (29 %) and three (14 %) cases in PDA, PT and OP area, respectively. Foxp3 and IgG4 were positively correlated in OP area, but not in PDA and PT area.

Conclusions

Clinicians should be careful when basing a differential diagnosis of PDA and AIP on the numbers of IgG4-positive cells and the ratio of IgG4/IgG, especially when determined using a small biopsied sample.
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Metadata
Title
The similarity of Type 1 autoimmune pancreatitis to pancreatic ductal adenocarcinoma with significant IgG4-positive plasma cell infiltration
Authors
Yuri Fukui
Kazushige Uchida
Kimi Sumimoto
Takeo Kusuda
Hideaki Miyoshi
Masanori Koyabu
Tsukasa Ikeura
Yutaku Sakaguchi
Masaaki Shimatani
Toshiro Fukui
Mitsunobu Matsushita
Makoto Takaoka
Akiyoshi Nishio
Nobuaki Shikata
Noriko Sakaida
Yoshiko Uemura
Sohei Satoi
A-hon Kwon
Kazuichi Okazaki
Publication date
01-06-2013
Publisher
Springer Japan
Published in
Journal of Gastroenterology / Issue 6/2013
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-012-0677-x

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