%0 Journal Article
%T Should Steroid Therapy Be Necessarily Needed for Autoimmune Pancreatitis Patients with Lesion Resected due to Misdiagnosed or Suspected Malignancy?
%A Wenchuan Wu
%A Xiuzhong Yao
%A Chao Lin
%A Dayong Jin
%A Dansong Wang
%A Wenhui Lou
%A Xinyu Qin
%J Gastroenterology Research and Practice
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/253471
%X To explore whether steroid therapy should be needed for autoimmune pancreatitis patients after operation, eight AIP patients receiving operation were enrolled in this study from January 2007 to July 2013. All patients underwent liver function, CA19-9, and contrast-enhanced CT and/or MRI. Tests of IgG and IgG4 were performed in some patients. Tests of serum TB/DB, ¦Ã-GT, and ¦Ã-globulin were undergone during the perioperative period. Six cases receiving resection were pathologically confirmed as AIP patients and two were confirmed by intraoperative biopsy. For seven patients, TB/DB level was transiently elevated 1 day or 4 days after operation but dropped below preoperative levels or to normal levels 7 days after operation, and serum ¦Ã-GT level presented a downward trend. Serum ¦Ã-globulin level exhibited a downward trend among six AIP patients after resection, while an upward trend was found in another two AIP patients receiving internal drainage. Steroid therapy was not given to all six AIP patients until two of them showed new lines of evidence of residual or extrapancreatic AIP lesion after operation, while another two cases without resection received steroid medication. Steroid therapy might not be recommended unless there are new lines of evidence of residual extrapancreatic AIP lesions after resection. 1. Introduction Patients with autoimmune pancreatitis (AIP) often receive unnecessary operation due to misdiagnosis for malignances, although they can be cured by steroid therapy without surgery [1, 2]. About 2.5% of patients receiving pancreaticoduodenectomy reported in the literature were pathologically confirmed as AIP [3¨C5]. Autoantibodies against pancreatic antigen are induced during the pathogenesis of autoimmune pancreatitis (AIP), which causes extensive infiltration of lymphocytes and plasma cells within pancreatic tissue around the pancreatic duct and diffuse enlargement of the pancreas. Similar manifestations may appear in the extrapancreatic organs due to the presence of common antigens. Actually, mechanism for antigens and antibodies of AIP has not been clearly elucidated. The diagnosis and disease severity of AIP are mainly dependent on a comprehensive assessment with serology, morphology, imaging, and therapeutics [6]. Similar to IgG, IgG4 is only the representative of the responsive level of antigen-specific antibody in the serum, although it is a key indicator among the diagnostic criteria for AIP [7, 8]. IgG4 is also related to the degree of AIP but does not directly represent the extent of lymphoplasmacytic infiltration into the
%U http://www.hindawi.com/journals/grp/2014/253471/