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Pancreatic Neoplasms: HELP
Articles by Terumi Kamisawa
Based on 30 articles published since 2010
(Why 30 articles?)
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Between 2010 and 2020, Terumi Kamisawa wrote the following 30 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. 2012

Ohara, Hirotaka / Okazaki, Kazuichi / Tsubouchi, Hirohito / Inui, Kazuo / Kawa, Shigeyuki / Kamisawa, Terumi / Tazuma, Susumu / Uchida, Kazushige / Hirano, Kenji / Yoshida, Hitoshi / Nishino, Takayoshi / Ko, Shigeru B H / Mizuno, Nobumasa / Hamano, Hideaki / Kanno, Atsushi / Notohara, Kenji / Hasebe, Osamu / Nakazawa, Takahiro / Nakanuma, Yasuni / Takikawa, Hajime / Anonymous3940729 / Anonymous3950729 / Anonymous3960729 / Anonymous3970729. ·Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. hohara@med.nagoya-cu.ac.jp ·J Hepatobiliary Pancreat Sci · Pubmed #22717980.

ABSTRACT: BACKGROUND: IgG4-sclerosing cholangitis (IgG4-SC) patients have an increased level of serum IgG4, dense infiltration of IgG4-positive plasma cells with extensive fibrosis in the bile duct wall, and a good response to steroid therapy. However, it is not easy to distinguish IgG4-SC from primary sclerosing cholangitis, pancreatic cancer, and cholangiocarcinoma on the basis of cholangiographic findings alone because various cholangiographic features of IgG4-SC are similar to those of the above progressive or malignant diseases. METHODS: The Research Committee of IgG4-related Diseases and the Research Committee of Intractable Diseases of Liver and Biliary Tract in association with the Ministry of Health, Labor and Welfare, Japan and the Japan Biliary Association have set up a working group consisting of researchers specializing in IgG4-SC, and established the new clinical diagnostic criteria of IgG4-SC 2012. RESULTS: The diagnosis of IgG4-SC is based on the combination of the following 4 criteria: (1) characteristic biliary imaging findings, (2) elevation of serum IgG4 concentrations, (3) the coexistence of IgG4-related diseases except those of the biliary tract, and (4) characteristic histopathological features. Furthermore, the effectiveness of steroid therapy is an optional extra diagnostic criterion to confirm accurate diagnosis of IgG4-SC. CONCLUSION: These diagnostic criteria for IgG4-SC are useful in practice for general physicians and other nonspecialists.

2 Editorial Strategy to differentiate autoimmune pancreatitis from pancreas cancer. 2012

Takuma, Kensuke / Kamisawa, Terumi / Gopalakrishna, Rajesh / Hara, Seiichi / Tabata, Taku / Inaba, Yoshihiko / Egawa, Naoto / Igarashi, Yoshinori. · ·World J Gastroenterol · Pubmed #22416175.

ABSTRACT: Autoimmune pancreatitis (AIP) is a newly described entity of pancreatitis in which the pathogenesis appears to involve autoimmune mechanisms. Based on histological and immunohistochemical examinations of various organs of AIP patients, AIP appears to be a pancreatic lesion reflecting a systemic "IgG4-related sclerosing disease". Clinically, AIP patients and patients with pancreatic cancer share many features, such as preponderance of elderly males, frequent initial symptom of painless jaundice, development of new-onset diabetes mellitus, and elevated levels of serum tumor markers. It is of uppermost importance not to misdiagnose AIP as pancreatic cancer. Since there is currently no diagnostic serological marker for AIP, and approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological, and histopathological features. Findings suggesting AIP rather than pancreatic cancer include: fluctuating obstructive jaundice; elevated serum IgG4 levels; diffuse enlargement of the pancreas; delayed enhancement of the enlarged pancreas and presence of a capsule-like rim on dynamic computed tomography; low apparent diffusion coefficient values on diffusion-weighted magnetic resonance image; irregular narrowing of the main pancreatic duct on endoscopic retrograde cholangiopancreatography; less upstream dilatation of the main pancreatic duct on magnetic resonance cholangiopancreatography, presence of other organ involvement such as bilateral salivary gland swelling, retroperitoneal fibrosis and hilar or intrahepatic sclerosing cholangitis; negative work-up for malignancy including endoscopic ultrasound-guided fine needle aspiration; and steroid responsiveness. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection.

3 Review Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. 2017

Tanaka, Masao / Fernández-Del Castillo, Carlos / Kamisawa, Terumi / Jang, Jin Young / Levy, Philippe / Ohtsuka, Takao / Salvia, Roberto / Shimizu, Yasuhiro / Tada, Minoru / Wolfgang, Christopher L. ·Department of Surgery, Shimonoseki City Hospital, Shimonoseki, Japan. Electronic address: masaotan@med.kyushu-u.ac.jp. · Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Department of Gastroenterology, Komagome Metropolitan Hospital, Tokyo, Japan. · Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. · Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hopital Beaujon, Clichy Cedex, France. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Dept. of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. · Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. · Cameron Division of Surgical Oncology and The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. ·Pancreatology · Pubmed #28735806.

ABSTRACT: The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasive carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required.

4 Review Pancreatic cancer. 2016

Kamisawa, Terumi / Wood, Laura D / Itoi, Takao / Takaori, Kyoichi. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. Electronic address: kamisawa@cick.jp. · The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University, Baltimore, USA. · Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. · Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. ·Lancet · Pubmed #26830752.

ABSTRACT: Pancreatic cancer is a highly lethal disease, for which mortality closely parallels incidence. Most patients with pancreatic cancer remain asymptomatic until the disease reaches an advanced stage. There is no standard programme for screening patients at high risk of pancreatic cancer (eg, those with a family history of pancreatic cancer and chronic pancreatitis). Most pancreatic cancers arise from microscopic non-invasive epithelial proliferations within the pancreatic ducts, referred to as pancreatic intraepithelial neoplasias. There are four major driver genes for pancreatic cancer: KRAS, CDKN2A, TP53, and SMAD4. KRAS mutation and alterations in CDKN2A are early events in pancreatic tumorigenesis. Endoscopic ultrasonography and endoscopic ultrasonography-guided fine-needle aspiration offer high diagnostic ability for pancreatic cancer. Surgical resection is regarded as the only potentially curative treatment, and adjuvant chemotherapy with gemcitabine or S-1, an oral fluoropyrimidine derivative, is given after surgery. FOLFIRINOX (fluorouracil, folinic acid [leucovorin], irinotecan, and oxaliplatin) and gemcitabine plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) are the treatments of choice for patients who are not surgical candidates but have good performance status.

5 Review Role of endoscopy in the diagnosis of autoimmune pancreatitis and immunoglobulin G4-related sclerosing cholangitis. 2014

Kamisawa, Terumi / Ohara, Hirotaka / Kim, Myung Hwan / Kanno, Atsushi / Okazaki, Kazuichi / Fujita, Naotaka. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Dig Endosc · Pubmed #24712522.

ABSTRACT: Autoimmune pancreatitis (AIP) must be differentiated from pancreatic carcinoma, and immunoglobulin (Ig)G4-related sclerosing cholangitis (SC) from cholangiocarcinoma and primary sclerosing cholangitis (PSC). Pancreatographic findings such as a long narrowing of the main pancreatic duct, lack of upstream dilatation, skipped narrowed lesions, and side branches arising from the narrowed portion suggest AIP rather than pancreatic carcinoma. Cholangiographic findings for PSC, including band-like stricture, beaded or pruned-tree appearance, or diverticulum-like outpouching are rarely observed in IgG4-SC patients, whereas dilatation after a long stricture of the bile duct is common in IgG4-SC. Transpapillary biopsy for bile duct stricture is useful to rule out cholangiocarcinoma and to support the diagnosis of IgG4-SC with IgG4-immunostaining. IgG4-immunostaining of biopsy specimens from the major papilla advances a diagnosis of AIP. Contrast-enhanced endoscopic ultrasonography (EUS) and EUS elastography have the potential to predict the histological nature of the lesions. Intraductal ultrasonographic finding of wall thickening in the non-stenotic bile duct on cholangiography is useful for distinguishing IgG4-SC from cholangiocarcinoma. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to exclude pancreatic carcinoma. To obtain adequate tissue samples for the histological diagnosis of AIP, EUS-Tru-cut biopsy or EUS-FNA using a 19-gauge needle is recommended, but EUS-FNA with a 22-gauge needle can also provide sufficient histological samples with careful sample processing after collection and rapid motion of the FNA needles within the pancreas. Validation of endoscopic imaging criteria and new techniques or devices to increase the diagnostic yield of endoscopic tissue sampling should be developed.

6 Review Autoimmune pancreatitis and IgG4-related sclerosing cholangitis. 2011

Takuma, Kensuke / Kamisawa, Terumi / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan. ·Curr Opin Rheumatol · Pubmed #21124090.

ABSTRACT: PURPOSE OF REVIEW: Autoimmune pancreatitis (AIP) is a peculiar type of pancreatitis with a presumed autoimmune etiology. AIP is frequently associated with stenosis of the bile duct in the form of IgG4-related sclerosing cholangitis. This article reviews recent advances in clinicopathological findings for AIP and IgG4-related sclerosing cholangitis. RECENT FINDINGS: AIP is currently diagnosed based on characteristic radiological findings (irregular narrowing of the main pancreatic duct and enlargement of the pancreas) in combination with serological findings (elevated serum IgG4 and presence of autoantibodies) and histopathological findings (dense infiltration of IgG4-positive plasma cells and lymphocytes with fibrosis and obliterative phlebitis in the pancreas). Other clinical characteristics include preponderance toward elderly men, common initial symptoms of obstructive jaundice, and favorable response to steroid therapy. Differentiation of AIP from pancreatic cancer is crucial. As AIP is frequently associated with various sclerosing extrapancreatic lesions showing the same peculiar histological findings seen in the pancreas, AIP is currently considered to represent a pancreatic manifestation of IgG4-related sclerosing disease. Considering the age of onset, associated diseases, cholangiography, serum IgG4 levels, and steroid responsiveness, IgG4-related sclerosing cholangitis differs from primary sclerosing cholangitis. SUMMARY: AIP and associated extrapancreatic lesions are considered to represent clinical manifestations of IgG4-related sclerosing disease.

7 Clinical Trial A Phase I Study of S-1 and Gemcitabine with Concurrent Radiotherapy in Patients with Non-Metastatic Advanced Pancreatic Cancer. 2015

Kobayashi, Shin / Honda, Goro / Kurata, Masanao / Okuda, Yukihiro / Sakamoto, Katsunori / Karasawa, Katsuyuki / Chang, Tachen / Egawa, Naoto / Kamisawa, Terumi / Omuro, Yasushi / Tsuruta, Koji. · ·Hepatogastroenterology · Pubmed #26902051.

ABSTRACT: BACKGROUND/AIMS: To determine the recommended dose (RD) for full-dose S-1 and low-dose gemcitabine combined with radiotherapy in patients with non-metastatic advanced pancreatic cancer. METHODOLOGY: Adult patients with non-metastatic advanced pancreatic cancer (Union for International Cancer Control T stage 3 or 4) were eligible. The weekly intravenous gemcitabine (level 0-1: 200 mg/ml,level 2: 300 mg/m on Days 1, 8, 15, 22, 29, 36) dose was escalated starting from level 1 in a 3+3 design along with full dose twice-daily oral S-1 (level 0: 60 mg/m2/day, level 1-2: 80 mg/ml/day), and was administered on the same days as radiotherapy (1.8 Gy x 28 days). RESULTS: Eight patients were included in this study. A dose-limiting toxicity (DLT) (grade 4 neutropenia) was observed in one of the first three patients in level 1, and three additional patients received the level 1 dose without any severe adverse events. DLTs (grade 3/4 neutropenia) were then observed in the first two patients given level 2 dose. Therefore, level 1 was designated as the RD. Common grade 3/4 toxicities included neutropenia (62.5%), anorexia (37.5%), and pneumonitis (12.5%). CONCLUSIONS: The combination of S-1 and gemcitabine with concurrent radiotherapy is a feasible regimen at the level 1 dose.

8 Clinical Trial Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study. 2011

Sugumar, Aravind / Levy, Michael J / Kamisawa, Terumi / Webster, G J / Kim, Myung-Hwan / Enders, Felicity / Amin, Zahir / Baron, Todd H / Chapman, Mike H / Church, Nicholas I / Clain, Jonathan E / Egawa, Naoto / Johnson, Gavin J / Okazaki, Kazuichi / Pearson, Randall K / Pereira, Stephen P / Petersen, Bret T / Read, Samantha / Sah, Raghuwansh P / Sandanayake, Neomal S / Takahashi, Naoki / Topazian, Mark D / Uchida, Kazushige / Vege, Santhi Swaroop / Chari, Suresh T. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. ·Gut · Pubmed #21131631.

ABSTRACT: BACKGROUND: Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined. METHODS: The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I. RESULTS: In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40). CONCLUSIONS: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.

9 Article Proposal for Endoscopic Ultrasonography Classification for Small Pancreatic Cancer. 2019

Terada, Shuzo / Kikuyama, Masataka / Kawaguchi, Shinya / Kanemoto, Hideyuki / Yokoi, Yoshihiro / Kamisawa, Terumi / Kuruma, Sawako / Chiba, Kazuro / Honda, Goro / Horiguchi, Shinichiro / Nakahodo, Jun. ·Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan. m01060st@jichi.ac.jp. · Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan. kikuyama110@yahoo.co.jp. · Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan. shinya-kawaguchi@i.shizuoka-pho.jp. · Department of Surgery, Shizuoka General Hospital, Shizuoka 420-8527, Japan. kanemot@gmail.com. · Department of Surgery, Shinshiro Municipal Hospital, Aichi 441-1387, Japan. y.yokoi@shinshirohp.jp. · Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan. kamisawa@cick.jp. · Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan. sawako@cick.jp. · Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan. kazuro_oruzak@yahoo.co.jp. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo 113-0021, Japan. ghon@cick.jp. · Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo 113-0021, Japan. s.horiguchi@cick.jp. · Department of Human Pathology, Juntendo University, Tokyo 113-8421, Japan. nakajun58@yahoo.co.jp. ·Diagnostics (Basel) · Pubmed #30678056.

ABSTRACT: BACKGROUNDS: Endoscopic ultrasonography (EUS) is used to observe the stricture of the main pancreatic duct (MPD) and in diagnosing pancreatic cancer (PC). We investigate the findings on EUS by referring to the histopathological findings of resected specimens. MATERIALS AND METHODS: Six patients with carcinoma in situ (CIS) and 30 patients with invasive carcinoma of 20 mm or less were included. The preoperative EUS findings were classified as follows. A1: Simple stricture type-no findings around the stricture; A2: Hypoecho stricture type-localized hypoechoic area without demarcation around the stricture; A3: Tumor stricture type-tumor on the stricture; B: Dilation type-the dilation of the pancreatic duct without a downstream stricture; C: Parenchymal tumor type-tumor located apart from the MPD. RESULTS: Classes A1 and A2 consisted of 2 CISs, and 4 invasive carcinomas included two cases smaller than 5 mm in diameter. Most of the cancers classified as A3 or C were of invasive carcinoma larger than 5 mm in diameter. All cancers classified as B involved CIS. Serial pancreatic-juice aspiration cytologic examination (SPACE) was selected for all types of cases, with a sensitivity of 92.0%, while EUS-guided fine needle aspiration cytology (EUS-FNA) was only useful for invasive carcinoma, and its sensitivity was 66.7%. CONCLUSIONS: Stricture without a tumor could be a finding for invasive PC and pancreatic duct dilation without a downstream stricture could be a finding indicative of CIS. Carcinoma smaller than 5 mm in diameter could not be recognized by EUS. SPACE had a high sensitivity for diagnosing small PC.

10 Article Acute obstructive suppurative pancreatic ductitis (AOSPD) in pancreatic cancer treated by nasopancreatic drainage. 2018

Shimizuguchi, Ryoko / Kikuyama, Masataka / Kamisawa, Terumi / Kuruma, Sawako / Chiba, Kazuro. ·Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. · Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. kikuyama110@cick.jp. ·Clin J Gastroenterol · Pubmed #29464657.

ABSTRACT: An 80-year-old woman with pancreatic cancer was admitted with fever and abdominal pain. Blood examinations showed an elevated CRP level. On computed tomography (CT), a pancreatic tumor with a dilated upstream main pancreatic duct (MPD) was seen. Endoscopic retrograde cholangiopancreatography (ERCP) showed the strictured part of the MPD at the head of the pancreas with upstream dilatation. A nasopancreatic drainage tube was placed. Through the tube, purulent pancreatic juice was discharged and culture of the pancreatic juice grew Klebsiella pneumoniae. On the day after ERCP, the patient's condition and the laboratory results improved. The patient's disorder was diagnosed as acute obstructive suppurative pancreatitis with pancreatic cancer.

11 Article Case-control study of diabetes-related genetic variants and pancreatic cancer risk in Japan. 2014

Kuruma, Sawako / Egawa, Naoto / Kurata, Masanao / Honda, Goro / Kamisawa, Terumi / Ueda, Junko / Ishii, Hiroshi / Ueno, Makoto / Nakao, Haruhisa / Mori, Mitsuru / Matsuo, Keitaro / Hosono, Satoyo / Ohkawa, Shinichi / Wakai, Kenji / Nakamura, Kozue / Tamakoshi, Akiko / Nojima, Masanori / Takahashi, Mami / Shimada, Kazuaki / Nishiyama, Takeshi / Kikuchi, Shogo / Lin, Yingsong. ·Sawako Kuruma, Terumi Kamisawa, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan. ·World J Gastroenterol · Pubmed #25516658.

ABSTRACT: AIM: To examine whether diabetes-related genetic variants are associated with pancreatic cancer risk. METHODS: We genotyped 7 single-nucleotide polymorphisms (SNPs) in PPARG2 (rs1801282), ADIPOQ (rs1501299), ADRB3 (rs4994), KCNQ1 (rs2237895), KCNJ11 (rs5219), TCF7L2 (rs7903146), and CDKAL1 (rs2206734), and examined their associations with pancreatic cancer risk in a multi-institute case-control study including 360 cases and 400 controls in Japan. A self-administered questionnaire was used to collect detailed information on lifestyle factors. Genotyping was performed using Fluidigm SNPtype assays. Unconditional logistic regression methods were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between these diabetes-associated variants and pancreatic cancer risk. RESULTS: With the exception of rs1501299 in the ADIPOQ gene (P = 0.09), no apparent differences in genotype frequencies were observed between cases and controls. Rs1501299 in the ADPIOQ gene was positively associated with pancreatic cancer risk; compared with individuals with the AA genotype, the age- and sex-adjusted OR was 1.79 (95%CI: 0.98-3.25) among those with the AC genotype and 1.86 (95%CI: 1.03-3.38) among those with the CC genotype. The ORs remained similar after additional adjustment for body mass index and cigarette smoking. In contrast, rs2237895 in the KCNQ1 gene was inversely related to pancreatic cancer risk, with a multivariable-adjusted OR of 0.62 (0.37-1.04) among individuals with the CC genotype compared with the AA genotype. No significant associations were noted for other 5 SNPs. CONCLUSION: Our case-control study indicates that rs1501299 in the ADIPOQ gene may be associated with pancreatic cancer risk. These findings should be replicated in additional studies.

12 Article Intraductal papillary mucinous neoplasm of the pancreas and IgG4-related disease: a coincidental association. 2013

Tabata, Taku / Kamisawa, Terumi / Hara, Seiichi / Kuruma, Sawako / Chiba, Kazuro / Kuwata, Go / Fujiwara, Takashi / Egashira, Hideto / Koizumi, Satomi / Endo, Yuka / Koizumi, Koichi / Fujiwara, Junko / Arakawa, Takeo / Momma, Kumiko / Horiguchi, Shinichiro / Hishima, Tsunekazu / Kurata, Masanao / Honda, Goro / Kloppel, Gunter. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. ·Pancreatology · Pubmed #23890136.

ABSTRACT: BACKGROUND/AIMS: Coexistence of autoimmune pancreatitis (AIP) and pancreatic cancer, elevation of serum IgG4 levels in pancreatic cancer patients, and infiltration of IgG4-positive plasma cells in peritumorous pancreatitis have been described in a few reports. This study examined the relationship between intraductal papillary mucinous neoplasm (IPMN) of the pancreas and peritumorous IgG4-positive lymphoplasmacytic infiltrates. METHODS: Serum IgG4 levels were measured in 54 patients with IPMN (median 70 years, 26 males and 28 females; 13 main duct type and 41 branch duct type). Histological findings focusing on dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis were reviewed, and immunostaining with IgG4 and IgG was performed in 23 surgically resected IPMN cases (18 main duct type and 5 branch duct type). The presence of IgG4-positive plasma cells >10/hpf and an IgG4-positive/IgG-positive plasma cell ratio >40% were considered significant. RESULTS: Serum IgG4 levels were elevated in 2 (4%) IPMN patients. Significant infiltration of IgG4-positive plasma cells was detected in 4 IPMN cases (17%). The IgG4-positive/IgG-positive plasma cell ratio was >40% in all 4 cases. In one case with a markedly elevated serum IgG4 level (624 mg/dL), typical lymphoplasmacytic sclerosing pancreatitis (AIP type 1) lesions surrounded the whole IPMN. In the 3 other cases, infiltration of IgG4-positive plasma cells with fibrosis was focally detected mainly in the periductal area around the IPMN. CONCLUSIONS: In a few patients with IPMNs, IgG4-positive plasma cell infiltration can occur in the peritumorous area. The association of an IPMN with AIP type 1-like changes seems to be exceptional and coincidental.

13 Article ABO blood type, long-standing diabetes, and the risk of pancreatic cancer. 2013

Egawa, Naoto / Lin, Yingsong / Tabata, Taku / Kuruma, Sawako / Hara, Seiichi / Kubota, Ken / Kamisawa, Terumi. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan. naoto_egawa@tmhp.jp ·World J Gastroenterol · Pubmed #23674856.

ABSTRACT: AIM: To retrospectively study pancreatic cancer patients with respect to their ABO blood type and diabetes. METHODS: Our analysis included a cohort of 1017 patients with pancreatic ductal cancer diagnosed at our hospital in Tokyo. They were divided into two groups: 114 patients with long-standing type 2 diabetes (DM group, defined as diabetes lasting for at least three years before the diagnosis of pancreatic cancer) and 903 patients without diabetes (non-DM group). Multivariate analysis was performed to identify factors that are associated with long-standing diabetes. The DM group was further divided into three subgroups according to the duration of diabetes (3-5 years, 5.1-14.9 years, and 15 years or more) and univariate analyses were performed. RESULTS: Of the 883 pancreatic cancer patients with serologically assessed ABO blood type, 217 (24.6%) had blood type O. Compared with the non-DM group, the DM group had a higher frequency of blood type B [odds ratio (OR) = 2.61, 95%CI: 1.24-5.47; reference group: blood type A]. Moreover, male (OR = 3.17, 95%CI: 1.67-6.06), older than 70 years of age (OR = 2.19, 95%CI: 1.20-3.98) and presence of a family history of diabetes (OR = 6.21, 95%CI: 3.38-11.36) were associated with long-standing type 2 diabetes. The mean ages were 64.8 ± 9.2 years, 67.1 ± 9.8 years, and 71.7 ± 7.0 years in the subgroups with the duration of diabetes, 3-5 years, 5.1-14.9 years, and 15 years or more, respectively (P = 0.007). A comparison of ABO blood type distribution among the subgroups also showed a significant difference (P = 0.03). CONCLUSION: The association of pancreatic cancer with blood type and duration of diabetes needs to be further examined in prospective studies.

14 Article Pancreatic cancer causing acute pancreatitis: a comparative study with cancer patients without pancreatitis and pancreatitis patients without cancer. 2013

Minato, Yohei / Kamisawa, Terumi / Tabata, Taku / Hara, Seiichi / Kuruma, Sawako / Chiba, Kazuro / Kuwata, Go / Fujiwara, Takashi / Egashira, Hideto / Koizumi, Koichi / Saito, Itaru / Endo, Yuka / Koizumi, Satomi / Fujiwara, Junko / Arakawa, Takeo / Momma, Kumiko / Kurata, Masanao / Honda, Goro. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan. ·J Hepatobiliary Pancreat Sci · Pubmed #23494612.

ABSTRACT: BACKGROUND/PURPOSE: Although pancreatic cancer produces upstream obstructive pancreatitis, acute pancreatitis is a less common manifestation of pancreatic cancer. This study aimed to clarify the subgroup of pancreatic cancer patients who present with an episode of acute pancreatitis (Group I) in comparison with a matched group of pancreatic cancer patients without pancreatitis (Group II) and another group of acute pancreatitis patients without pancreatic cancer (Group III). METHODS: This was a retrospective comparative study of 18 patients in Group I, 300 patients in Group II and 141 patients in Group III. RESULTS: The mean age of Group I was 63.7 years and the male to female ration was 1:0.3. Serum CA 19-9 levels were elevated in 80 %. The main pancreatic duct was incompletely obstructed in 7 patients. There were no significant differences in location of tumor, clinical stage, resection rate and survival months between Group I and II. Acute pancreatitis secondary to pancreatic cancer was more likely to be mild (94 vs. 72 %,p < 0.05) and relapsed (39 vs. 16 %,p < 0.05) compared with Group III. CONCLUSIONS: Anatomic evaluation of the pancreas should be performed in patients with acute pancreatitis with no obvious etiology, even if the pancreatitis is mild, to search for underlying malignancy.

15 Article Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. 2013

Hart, Phil A / Kamisawa, Terumi / Brugge, William R / Chung, Jae Bock / Culver, Emma L / Czakó, László / Frulloni, Luca / Go, Vay Liang W / Gress, Thomas M / Kim, Myung-Hwan / Kawa, Shigeyuki / Lee, Kyu Taek / Lerch, Markus M / Liao, Wei-Chih / Löhr, Matthias / Okazaki, Kazuichi / Ryu, Ji Kon / Schleinitz, Nicolas / Shimizu, Kyoko / Shimosegawa, Tooru / Soetikno, Roy / Webster, George / Yadav, Dhiraj / Zen, Yoh / Chari, Suresh T. ·Division of Gastroenterology and Hepatology, Mayo Clinic, , Rochester, Minnesota, USA. ·Gut · Pubmed #23232048.

ABSTRACT: OBJECTIVE: Autoimmune pancreatitis (AIP) is a treatable form of chronic pancreatitis that has been increasingly recognised over the last decade. We set out to better understand the current burden of AIP at several academic institutions diagnosed using the International Consensus Diagnostic Criteria, and to describe long-term outcomes, including organs involved, treatments, relapse frequency and long-term sequelae. DESIGN: 23 institutions from 10 different countries participated in this multinational analysis. A total of 1064 patients meeting the International Consensus Diagnostic Criteria for type 1 (n=978) or type 2 (n=86) AIP were included. Data regarding treatments, relapses and sequelae were obtained. RESULTS: The majority of patients with type 1 (99%) and type 2 (92%) AIP who were treated with steroids went into clinical remission. Most patients with jaundice required biliary stent placement (71% of type 1 and 77% of type 2 AIP). Relapses were more common in patients with type 1 (31%) versus type 2 AIP (9%, p<0.001), especially those with IgG4-related sclerosing cholangitis (56% vs 26%, p<0.001). Relapses typically occurred in the pancreas or biliary tree. Retreatment with steroids remained effective at inducing remission with or without alternative treatment, such as azathioprine. Pancreatic duct stones and cancer were uncommon sequelae in type 1 AIP and did not occur in type 2 AIP during the study period. CONCLUSIONS: AIP is a global disease which uniformly displays a high response to steroid treatment and tendency to relapse in the pancreas and biliary tree. Potential long-term sequelae include pancreatic duct stones and malignancy, however they were uncommon during the study period and require additional follow-up. Additional studies investigating prevention and treatment of disease relapses are needed.

16 Article Diagnostic and therapeutic peroral direct cholangioscopy in patients with altered GI anatomy (with videos). 2012

Itoi, Takao / Sofuni, Atsushi / Itokawa, Fumihide / Kurihara, Toshio / Tsuchiya, Takayoshi / Ishii, Kentaro / Ikeuchi, Nobuhito / Moriyasu, Fuminori / Kasuya, Kazuhiko / Tsuchida, Akihiko / Kamisawa, Terumi / Baron, Todd H. ·Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. ·Gastrointest Endosc · Pubmed #22154415.

ABSTRACT: -- No abstract --

17 Article Main-duct intraductal papillary mucinous adenoma of the pancreas. 2011

Takuma, Kensuke / Kamisawa, Terumi / Tabata, Taku / Kurata, Masanao / Honda, Goro / Horiguchi, Shin-Ichiro. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·World J Surg Oncol · Pubmed #22112163.

ABSTRACT: BACKGROUND: The prevalence of carcinoma in main-duct intraductal papillary mucinous neoplasm (IPMN) is high, and surgical resection is recommended for all patients with a main-duct IPMN. RESULTS: A main-duct IPMN with typical imagings including protruding lesions in the dilated main pancreatic duct was resected, but the histology was intraductal papillary mucinous adenoma of the pancreas. DISCUSSION: It has been reported that the presence of mural nodules and dilatation of MPD are significantly higher in malignant IPMNs. The presented case had protruding lesions in the dilated main pancreatic duct on endoscopic ultrasonography, but the histology was adenoma. CONCLUSION: Preoperative distinction between benign and malignant IPMNs is difficult.

18 Article Incidence of and risk factors for developing pancreatic cancer in patients with chronic pancreatitis. 2011

Kudo, Yujin / Kamisawa, Terumi / Anjiki, Hajime / Takuma, Kensuke / Egawa, Naoto. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Hepatogastroenterology · Pubmed #21661440.

ABSTRACT: BACKGROUND/AIMS: Pancreatic cancer sometimes occurs during the course of chronic pancreatitis. This study aimed to identify risk factors for developing pancreatic cancer associated with chronic pancreatitis. METHODOLOGY: The incidence of pancreatic cancer developing in 218 patients with chronic pancreatitis and clinical features of the chronic pancreatitis patients who developed pancreatic cancer were studied. RESULTS: Nine patients developed pancreatic cancer. Average period from the diagnosis of chronic pancreatitis to the diagnosis of pancreatic cancer was 9.6 years. All pancreatic cancers were diagnosed at an advanced stage. Only 2 patients had been followed-up periodically. There were no significant differences between chronic pancreatitis patients who developed pancreatic cancer and those who did not in male/female ratio (3.5 vs. 8), average age on diagnosis (65.0 vs. 56.5), alcoholic/non-alcoholic chronic pancreatitis (1.6 vs. 2.6), smoking habits (62.5% vs. 70.7%), diabetes mellitus (77.8% vs. 54.4%), and continued alcohol drinking (37.5% vs. 53.1%). CONCLUSIONS: Over the period examined, 4% of chronic pancreatitis patients developed pancreatic cancer. Sex ratio, onset age, etiology, smoking habits, diabetes mellitus, and continued alcohol drinking were not significant risk factors for developing pancreatic cancer in chronic pancreatitis patients. Periodic follow-up due to the possibility of pancreatic cancer is necessary in chronic pancreatitis patients.

19 Article Utility of pancreatography for diagnosing autoimmune pancreatitis. 2011

Takuma, Kensuke / Kamisawa, Terumi / Tabata, Taku / Inaba, Yoshihiko / Egawa, Naoto / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan. ·World J Gastroenterol · Pubmed #21633599.

ABSTRACT: AIM: To identify pancreatographic findings that facilitate differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) on endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). METHODS: ERCP findings of 48 AIP and 143 PC patients were compared. Diagnostic accuracies for AIP by ERCP and MRCP were compared in 30 AIP patients. RESULTS: The following ERCP findings suggested a diagnosis of AIP rather than PC. Obstruction of the main pancreatic duct (MPD) was more frequently detected in PC (P < 0.001). Skipped MPD lesions were detected only in AIP (P < 0.001). Side branch derivation from the narrowed MPD was more frequent in AIP (P < 0.001). The narrowed MPD was longer in AIP (P < 0.001), and a narrowed MPD longer than 3 cm was more frequent in AIP (P < 0.001). Maximal diameter of the upstream MPD was smaller in AIP (P < 0.001), and upstream dilatation of the MPD less than 5 mm was more frequent in AIP (P < 0.001). Stenosis of the lower bile duct was smooth in 87% of AIP and irregular in 65% of PC patients (P < 0.001). Stenosis of the intrahepatic or hilar bile duct was detected only in AIP (P = 0.001). On MRCP, diffuse narrowing of the MPD on ERCP was shown as a skipped non-visualized lesion in 50% and faint visualization in 19%, but segmental narrowing of the MPD was visualized faintly in only 14%. CONCLUSION: Several ERCP findings are useful for differentiating AIP from PC. Although MRCP cannot replace ERCP for the diagnostic evaluation of AIP, some MRCP findings support the diagnosis of AIP.

20 Article Long-term follow-up of chronic pancreatitis patients with K-ras mutation in the pancreatic juice. 2011

Kamisawa, Terumi / Takuma, Kensuke / Tabata, Taku / Egawa, Naoto / Yamaguchi, Toshikazu. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. kamisawa@cick.jp ·Hepatogastroenterology · Pubmed #21510309.

ABSTRACT: BACKGROUND/AIMS: Pancreatic cancer is known to occur during the course of chronic pancreatitis in some patients. This study aimed to identify a high risk group for developing pancreatic cancer associated with chronic pancreatitis, particularly the presence of K-ras mutations in the pancreatic juice. METHODOLOGY: K-ras mutation was analyzed by enriched polymerase chain reaction-enzyme linked mini-sequence assay in endoscopically-collected pancreatic juice of 21 patients with chronic pancreatitis between 1995 and 2000. All of them were followed-up for 6.0 +/- 3.8 (mean +/- SD) years (range, 2.1-14.2 years). RESULTS: K-ras point mutation was observed in the pancreatic juice of 11 patients with chronic pancreatitis (2+, n=2; 1+, n=6; +/-, n=3). Of these, 2 chronic pancreatitis patients with 2+K-ras point mutation developed pancreatic cancer 4.5 and 10.8 years, respectively, after the examination. CONCLUSIONS: Two chronic pancreatitis patients with K-ras mutation developed pancreatic cancer 4.5 and 10.8 years later. Semiquantitative analysis of K-ras mutation in endoscopically-collected pancreatic juice appears to be a useful tool for identifying chronic pancreatitis patients at high risk for developing pancreatic cancer.

21 Article EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses. 2011

Itokawa, Fumihide / Itoi, Takao / Sofuni, Atsushi / Kurihara, Toshio / Tsuchiya, Takayoshi / Ishii, Kentaro / Tsuji, Shujiro / Ikeuchi, Nobuhito / Umeda, Junko / Tanaka, Reina / Yokoyama, Naoyuki / Moriyasu, Fuminori / Kasuya, Kazuhiko / Nagao, Toshitaka / Kamisawa, Terumi / Tsuchida, Akihiko. ·Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. ·J Gastroenterol · Pubmed #21505859.

ABSTRACT: BACKGROUND: Recently, the usefulness of endoscopic ultrasound (EUS) elastography has been reported for the diagnosis of pancreatic lesions. In the present study, we retrospectively assessed EUS elastography as a diagnostic tool by evaluating tissue elasticity distribution and elasticity semiquantification, using the strain ratio (SR) of tissue elasticity, in patients with pancreatic masses. METHODS: One hundred and nine patients who underwent EUS elastography between September 2006 and May 2009 were retrospectively evaluated. The final diagnosis was chronic pancreatitis (CP) in 20 patients [6 with non-mass-forming pancreatitis, 7 with mass-forming pancreatitis (MFP), and 7 with autoimmune pancreatitis (AIP)], pancreatic cancer (PC) in 72, pancreatic neuroendocrine tumor (PNET) in 9, and normal pancreas in 8. The tissue elasticity distribution calculation was performed in real time, and the results were represented in color in fundamental B-mode imaging. In addition, we performed quantification using the SR (non-mass area/mass area). RESULTS: Elastography for all PC patients showed intense blue coloration, indicating malignant lesions. In contrast, MFP presented with a mixed coloration pattern of green, yellow, and low-intensity blue. Normal controls showed an even distribution of green to red. The mean SR was 23.66 ± 12.65 for MFP and 39.08 ± 20.54 for PC (P < 0.05). CONCLUSIONS: Endoscopic ultrasound elastography is a promising diagnostic tool for defining the tissue characteristics of pancreatic masses. In addition, semiquantitative analysis of elasticity using the SR may allow the differentiation of MFP from PC.

22 Article Serial changes of elevated serum IgG4 levels in IgG4-related systemic disease. 2011

Tabata, Taku / Kamisawa, Terumi / Takuma, Kensuke / Egawa, Naoto / Setoguchi, Keigo / Tsuruta, Koji / Obayashi, Taminori / Sasaki, Tsuneo. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Intern Med · Pubmed #21245628.

ABSTRACT: OBJECTIVE: Autoimmune pancreatitis (AIP) and Mikulicz's disease have recently been recognized as pancreatic or salivary gland lesions of IgG4-related systemic disease. These are frequently associated with elevated serum IgG4 levels. This study aimed to clarify clinical implications of serial changes of elevated serum IgG4 levels in IgG4-related systemic diseases. METHODS: Serial changes of elevated serum IgG4 levels were examined in patients with IgG4-related systemic diseases. Patients Serial changes of elevated serum IgG4 levels were examined in 44 patients: AIP (n=24), Mikulicz's disease (n=8), pancreatic cancer (n=5), bile duct cancer (n=1), sclerosing cholangitis (n=1), hypereosinophilic syndrome (n=1), chronic thyroiditis (n=1), hypophysitis (n=1), idiopathic pancreatitis (n=1), and Behcet's disease (n=1). RESULTS: The serum IgG4 levels decreased in all patients with AIP and Mikulicz's disease after steroid therapy. The serum IgG4 levels were normalized in 46% of AIP patients and 38% of Mikulicz's disease patients. The serum IgG4 levels were not normalized at remission in 3 of 4 relapsed AIP patients, and re-elevation of serum IgG4 levels was detected in all relapsed patients. Elevated serum IgG4 levels decreased in 3 patients with pancreatic cancer after resection or chemotherapy, and decreased in patients with hypereosinophilic syndrome, sclerosing cholangitis, and hypophysitis after steroid therapy. CONCLUSION: Measurement of serial serum IgG4 levels is useful to determine the disease activity of IgG4-related systemic diseases.

23 Article Predictors of malignancy and natural history of main-duct intraductal papillary mucinous neoplasms of the pancreas. 2011

Takuma, Kensuke / Kamisawa, Terumi / Anjiki, Hajime / Egawa, Naoto / Kurata, Masanao / Honda, Goro / Tsuruta, Koji / Horiguchi, Shin-Ichiro / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Pancreas · Pubmed #21206326.

ABSTRACT: OBJECTIVES: Because the prevalence of carcinoma is high in main-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, surgical resection is recommended for all main-duct type IPMNs. This study aimed to investigate the clinical predictors of malignancy and natural history of main-duct IPMNs. METHODS: Preoperative clinical characteristics reliably correlated with malignancy in 26 surgically resected patients with main-duct IPMN, and long-term outcome in 20 conservatively followed patients with main-duct IPMN was examined. RESULTS: Age at diagnosis was significantly older in conservatively followed IPMN patients than in surgically resected IPMN patients. Main pancreatic duct (MPD) dilatation 10 mm or greater and mural nodules were significantly more frequent in malignant IPMNs. Obvious progression of dilatation of the MPD was detected in all 4 conservatively followed patients who developed invasive pancreatic carcinoma. The histology of IPMN at autopsy of 4 conservatively followed patients who died of other causes 21 to 120 months later was adenoma. Seven conservatively followed without malignant findings did not show obvious progression of MPD dilatation. CONCLUSIONS: Although surgical resection is indicated for many main-duct IPMNs, conservative follow-up may be an option for elderly asymptomatic patients with main-duct IPMNs with the MPD less than 10 mm, no obvious mural nodule, and negative cytology.

24 Article Large cystic acinar cell carcinoma of the pancreas. 2011

Kamisawa, Terumi / Tsuruta, Koji / Horiguchi, Shin-Ichiro. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. kamisawa@cick.jp ·J Hepatobiliary Pancreat Sci · Pubmed #20936304.

ABSTRACT: Acinar cell carcinoma of the pancreas is a rare neoplasm exhibiting pancreatic enzyme production by the neoplastic cells. It has a highly characteristic cellular arrangement reflecting its acinar derivation, and a definite diagnosis is made based on immunohistochemical and ultrastructural results. Such tumors are often large but rather well circumscribed. Some cases have a cystic appearance due to hemorrhage or necrosis, but a large cystic mass appearing as a pseudocyst is quite rare. We present a large cystic acinar cell carcinoma of the pancreas.

25 Article Endoscopic approach for diagnosing autoimmune pancreatitis. 2010

Kamisawa, Terumi / Anjiki, Hajime / Takuma, Kensuku / Egawa, Naoto / Itoi, Takao / Itokawa, Fumihide. ·Terumi Kamisawa, Hajime Anjiki, Kensuku Takuma, Naoto Egawa, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan. ·World J Gastrointest Endosc · Pubmed #21160674.

ABSTRACT: It is of utmost importance to differentiate autoimmune pancreatitis (AIP) from pancreatic cancer (PC). Segmental AIP cases are sometimes difficult to differentiate from PC. On endoscopic retrograde cholangiopancreatography, long or skipped irregular narrowing of the main pancreatic duct (MPD), less upstream dilatation of the distal MPD, side branches derived from the narrowed portion of the MPD, absence of obstruction of the MPD, and stenosis of the intrahepatic bile duct suggest AIP rather than PC. Abundant infiltration of IgG4-positive plasma cells is frequently and rather specifically detected in the major duodenal papilla of AIP patients. IgG4-immunostaining of biopsy specimens obtained from the major duodenal papilla is useful for supporting a diagnosis of AIP with pancreatic head involvement. On endoscopic ultrasonography (EUS), hyperechoic spots in the hypoechoic mass and the duct-penetrating sign suggest AIP rather than PC. EUS and intraductal ultrasonography sometimes show wall thickening of the common bile duct even in the segment in which abnormalities are not clearly observed with cholangiography in AIP patients. EUS-guided fine needle aspiration, especially EUS-guided Tru-Cut biopsy, is useful to diagnose AIP, as well as to exclude PC.

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