1.A Case of Systemic Amyloidosis with Pancreatic Involvement Mimicking Autoimmune Pancreatitis.
Jin Yong PARK ; Hyung Joon YIM ; Ik YOON ; Sun Min PARK ; Jin Nam KIM ; Hong Sik LEE ; Sang Woo LEE ; Jai Hyun CHOI
The Korean Journal of Gastroenterology 2008;52(6):399-403
Systemic amyloidosis is a disorder characterized by extracellular deposition of amyloid in various organs and tissues including the kidney, heart, and liver. However, pancreatic involvement is rare, and has not been reported in Korea. Systemic amyloisosis involving pancreas needs to be differentiated from several pancreatic diseases because of diffuse pancreatic enlargement and partial stricture or obstruction of main pancreatic duct. Recently, we experienced a 60-year old man who was suspected as autoimmune pancreatitis or infiltrative disorders on imaging studies, and finally diagnosed as systemic amyloidosis involving pancreas and liver on biopsy examination. We report the case with review of the relevant literatures.
Amyloidosis/*diagnosis/pathology/radiography
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Autoimmune Diseases/diagnosis
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Cholangiopancreatography, Endoscopic Retrograde
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Diagnosis, Differential
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Humans
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Male
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Middle Aged
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Pancreatic Diseases/*diagnosis
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Pancreatitis/diagnosis/immunology/pathology
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Tomography, X-Ray Computed
2.Clinical Characteristics of Autoimmune Pancreatitis.
Mi Jin KIM ; Cho Rong OH ; Kyu Taek LEE
The Korean Journal of Gastroenterology 2010;56(5):276-284
Korean autoimmune pancreatitis (AIP) criteria 2007 was aimed to diagnose the wide spectrum of AIP with high sensitivity. The most crucial issue when caring for patients with suspected AIP is to differentiate AIP from pancreatic cancer. Pancreatic cancer can be distinguished from AIP by pancreatic imaging, measurement of serum IgG4 levels, endoscopic ultrasound guided fine needle aspiration and trucut biopsy, and steroid trial. Autoimmune pancreatitis is a rare systemic fibroinflammatory disease which can affect not only the pancreas, but also a variety of organs such as the bile ducts, salivary glands, retroperitoneum, and lymph nodes. Organs affected by AIP have a lymphoplasmacytic infiltrate rich in IgG4-positive cells. This inflammatory process responds dramatically to oral steroid therapy. Granulocytic epithelial lesion (GEL) positive AIP patients differ from GEL negative AIP patients in clinical features such as equal gender ratio, younger mean age, no increase in serum IgG4, no association with extrapancreatic involvement, no relapse, and frequent association with inflammatory bowel disease. Further investigation is needed to clarify the pathogenic mechanisms including more definite serological markers for theses two entities.
Autoimmune Diseases/*diagnosis/pathology/ultrasonography
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Common Bile Duct/radiography
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Fibrosis/pathology
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Humans
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Immunoglobulin G/blood
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Pancreatitis/*diagnosis/pathology/ultrasonography
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Salivary Glands/pathology
3.Comparison of Clinical Findings between Autoimmune Pancreatitis with Bile Duct Involvement and Primary Sclerosing Cholangitis.
Ja Young KIM ; Myung Hwan KIM ; Ji Hoon JUNG ; Ju Hyung SONG ; Hyoung Chul OH ; Seung Hyun KWON ; Tae Yoon LEE ; Sang Soo LEE ; Dong Wan SEO ; Sung Koo LEE
The Korean Journal of Gastroenterology 2006;48(2):104-111
BACKGOUND/AIMS: The involvement of bile ducts is frequently reported in autoimmune pancreatitis (AIP), which seem to have similar features to primary sclerosing cholangitis (PSC). Recent systematic comparative studies about these diseases are rare in Korea. METHODS: We retrospectively analyzed 26 patients with AIP with bile duct involvement and 30 patients with classic PSC who were diagnosed during the last decade. RESULTS: The mean age of patients was significantly higher in AIP than PSC at the time of diagnosis. There was a preponderance of men in both group, which was more prominent in AIP. The most common symptom in patients with AIP was jaundice, but PSC patients usually visited hospitals due to incidentally detected abnormal liver function tests. Most (26/31) of AIP had bile duct involvement. All of these patients showed narrowing of intrapancreatic common bile ducts and one patient exhibited hilar involvement as well. About 80% of PSC had both intra- and extrahepatic ducts involvement, and the characteristic features involve multifocal strictures. AIP patients showed improvement with steroid treatment, however, most PSC patients showed clinical deterioration. CONCLUSIONS: The clinical and cholangiographic findings of patients with AIP and PSC have many different characteristics. Therefore, further study of two diseases is required for the proper diagnosis and management.
Autoimmune Diseases/*diagnosis/pathology/radiography
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Bile Ducts/pathology
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*Cholangiography
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Cholangiopancreatography, Endoscopic Retrograde
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Cholangitis, Sclerosing/*diagnosis/pathology/radiography
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Diagnosis, Differential
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Female
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Humans
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Immunoglobulins/blood
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Male
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Pancreatitis/*diagnosis/*immunology/pathology
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Retrospective Studies
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Sex Factors
4.Suspected Pulmonary Involvement of Autoimmune Pancreatitis.
Seungmin BANG ; Jeong Youp PARK
The Korean Journal of Gastroenterology 2011;58(1):58-60
No abstract available.
Autoimmune Diseases/*diagnosis/drug therapy/immunology
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Azathioprine/therapeutic use
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Common Bile Duct/pathology
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Emphysema
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Fibrosis
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Humans
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Immunoglobulin G/blood
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Immunosuppressive Agents/therapeutic use
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Lung/*radiography
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Male
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Middle Aged
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Pancreatitis/*diagnosis/drug therapy/immunology
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Stents
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Tomography, X-Ray Computed
5.Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis.
Su Mi WOO ; Myung Hwan NOH ; Byung Geun KIM ; Chien Ter HSING ; Ji Sun HAN ; Seung Hee RYU ; Jeong Min SEO ; Hyun Ah YOON ; Jin Seok JANG ; Seok Reyol CHOI ; Jin Han CHO
The Korean Journal of Gastroenterology 2011;58(1):31-37
BACKGROUND/AIMS: The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers. METHODS: Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission. RESULTS: Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021). CONCLUSIONS: Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis.
APACHE
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Acute Disease
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Adult
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Aged
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Aged, 80 and over
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Area Under Curve
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Biological Markers/blood
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C-Reactive Protein/analysis
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Calcitonin/*blood
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Female
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Humans
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L-Lactate Dehydrogenase/blood
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Length of Stay
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Logistic Models
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Male
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Middle Aged
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Pancreatitis/*diagnosis/pathology/radiography
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Predictive Value of Tests
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Protein Precursors/*blood
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*Severity of Illness Index
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Urea/blood
6.Pancreatitis from Metastatic Small Cell Lung Cancer: Successful Treatment with Endoscopic Intrapancreatic Stenting.
Jong Shin WOO ; Kwang Ro JOO ; Yong Sik WOO ; Jae Young JANG ; Young Woon CHANG ; Joung Il LEE ; Rin CHANG
The Korean Journal of Internal Medicine 2006;21(4):256-261
Lung cancer metastases can occur in almost any organ. However, metastasis of small cell lung cancer to the pancreas is rare. Moreover, not all cases present with clinically diagnosed pancreatitis. We recently treated a patient with small cell lung carcinoma that invaded the pancreatic duct causing acute pancreatitis. Generally, the treatment for tumor-induced acute pancreatitis is initially supportive followed by aggressive chemotherapy or surgery. If the patient can tolerate the insertion of an endoscopic intrapancreatic stent, this is performed in addition to chemotherapy and surgery; this approach offers a safe and effective treatment modality for such patients.
Tomography, X-Ray Computed
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*Stents
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Prosthesis Implantation/*methods
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Pneumonectomy
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Pancreatitis/diagnosis/etiology/*surgery
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Pancreatic Neoplasms/*complications/secondary/therapy
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Pancreatic Ducts/radiography/*surgery/ultrasonography
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Middle Aged
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Lung Neoplasms/*pathology/therapy
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Humans
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Follow-Up Studies
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Female
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Endosonography
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Cholangiopancreatography, Endoscopic Retrograde
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Carcinoma, Small Cell/*complications/secondary/therapy
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Antineoplastic Agents/therapeutic use