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Extrapancreatic Lesions in Autoimmune Pancreatitis

Kamisawa, Terumi MD, PhD*; Egawa, Naoto MD*; Nakajima, Hitoshi MD, PhD*; Tsuruta, Kouji MD, PhD; Okamoto, Atsutake MD, PhD

Journal of Clinical Gastroenterology: November-December 2005 - Volume 39 - Issue 10 - p 904-907
doi: 10.1097/01.mcg.0000180629.77066.6c
Liver, Pancreas, and Biliary Tract: Clinical Research
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Goals: To examine extrapancreatic lesions associated with autoimmune pancreatitis.

Background: Autoimmune pancreatitis is a unique clinical entity proposed recently, and is reported to occasionally be associated with other autoimmune diseases.

Study: Extrapancreatic lesions were examined clinically, radiologically, and histologically in 25 patients with autoimmune pancreatitis.

Results: Stenosis of the bile duct was observed in 22 patients (lower bile duct [n = 19], upper bile duct [n = 1], intrahepatic bile duct [n = 2]). Marked extrapancreatic bile duct wall thickening not associated with obvious cholangiographic abnormality was seen on ultrasound in 3 patients. Enlargement of the salivary glands and cervical lymph nodes was detected in 4 patients. Abdominal lymphadenopathy was observed in 5 of 8 patients at laparotomy. Retroperitoneal fibrosis was noted in 2 patients. Obliterative phlebitis of the pancreatic and peripancreatic veins was observed histologically in all 6 resected specimens. Marked stenosis of the portal vein and encasement of the peripancreatic arteries was observed in 4 and 8 of 14 patients who underwent abdominal angiography, respectively. Diabetes mellitus was diagnosed in 13 patients. All associated extrapancreatic lesions except diabetes mellitus improved after steroid therapy.

Conclusions: Extrapancreatic lesions found to be occasionally associated with autoimmune pancreatitis were stenosis of the bile duct, enlargement of the salivary glands, abdominal or cervical lymphadenopathy, retroperitoneal fibrosis, stenosis of the peripancreatic arteries or portal vein, and diabetes mellitus. It is possible that these lesions are induced by the same inflammatory mechanisms as autoimmune pancreatitis.

From the Departments of *Internal Medicine and †Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.

Received for publication February 2, 2005; accepted May 25, 2005.

Reprints: Terumi Kamisawa, MD, PhD, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan (e-mail: kamisawa@cick.jp).

© 2005 Lippincott Williams & Wilkins, Inc.