Pancreatic ductal adenocarcinoma with autoimmune pancreatitis-like histologic and immunohistochemical features.


Journal Article

Autoimmune pancreatitis (AIP) often manifests as a mass lesion causing obstructive jaundice, clinically mimicking pancreatic carcinoma. A diagnosis of AIP may obviate the need for surgical resection, as most patients respond to steroid treatment. However, it is not clear whether these 2 conditions can coexist. In this study, 105 specimens resected for pancreatic ductal adenocarcinoma (PDAC) that also have changes of chronic pancreatitis were examined for features considered to be characteristic of AIP. Of 105 cases of PDAC with changes of chronic pancreatitis, 10 (9.5%) exhibited histologic features of AIP, including exuberant fibrosis, lymphoplasmacytic infiltration, obliterative phlebitis, or granulocytic epithelial lesions. Of these 10 cases, 7 had more than 20 immunoglobulin G4+ plasma cells per high-power field. Of these 7 cases, 5 were analyzed for Kirsten rat sarcoma viral oncogene mutation and SMAD4 expression. Three cases showed K-ras mutation and/or loss of SMAD4 expression in benign AIP-like areas. These findings suggest 2 possibilities: first, AIP-like lesions may occur in a small but significant portion of PDAC cases; second, some PDACs may arise in a background of AIP. Therefore, caution is necessary when making a diagnosis of AIP by needle biopsy of a mass lesion, and patients with a tentative AIP diagnosis should be closely followed up clinically.

Full Text

Duke Authors

Cited Authors

  • Zhang, X; Liu, X; Joseph, L; Zhao, L; Hart, J; Xiao, S-Y

Published Date

  • March 2014

Published In

Volume / Issue

  • 45 / 3

Start / End Page

  • 621 - 627

PubMed ID

  • 24457081

Pubmed Central ID

  • 24457081

Electronic International Standard Serial Number (EISSN)

  • 1532-8392

Digital Object Identifier (DOI)

  • 10.1016/j.humpath.2013.08.027


  • eng

Conference Location

  • United States