Differentiating Immunoglobulin G4-Related Sclerosing Cholangitis from Hilar Cholangiocarcinoma.
- Author:
Taku TABATA
1
;
Terumi KAMISAWA
;
Seiichi HARA
;
Sawako KURUMA
;
Kazuro CHIBA
;
Go KUWATA
;
Takashi FUJIWARA
;
Hideto EGASHIRA
;
Koichi KOIZUMI
;
Junko FUJIWARA
;
Takeo ARAKAWA
;
Kumiko MOMMA
;
Masanao KURATA
;
Goro HONDA
;
Koji TSURUTA
;
Takao ITOI
Author Information
1. Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. kamisawa@cick.jp
- Publication Type:Original Article
- Keywords:
Immunoglobulin G;
IgG4-ralated sclerosing cholangitis;
Hilar cholangiocarcinoma;
Endoscopic retrograde cholangiopancreatography
- MeSH:
Bile Ducts;
Bilirubin;
Cholangiocarcinoma;
Cholangiography;
Cholangiopancreatography, Endoscopic Retrograde;
Cholangitis, Sclerosing;
Constriction, Pathologic;
Hepatic Duct, Common;
Humans;
Immunoglobulin G;
Immunoglobulins;
Jaundice, Obstructive;
Lacrimal Apparatus;
Pancreas;
Retrospective Studies
- From:Gut and Liver
2013;7(2):234-238
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Few studies have differentiated immunoglobulin G (IgG) 4-related sclerosing cholangitis (IgG4-SC) from hilar cholangiocarcinoma (CC). Thus, we sought to investigate useful features for differentiating IgG4-SC from hilar CC. METHODS: We retrospectively compared clinical, serological, imaging, and histological features of six patients with IgG4-SC and 42 patients with hilar CC. RESULTS: In patients with hilar CC, obstructive jaundice was more frequent (p<0.01), serum total bilirubin levels were significantly higher (p<0.05), serum CA19-9 levels were significantly higher (p<0.01), and serum duke pancreatic monoclonal antigen type 2 levels were frequently elevated (p<0.05). However, in patients with IgG4-SC, the serum IgG (p<0.05) and IgG4 (p<0.01) levels were significantly higher and frequently elevated. The pancreas was enlarged in all IgG4-SC patients but only in 17% of hilar CC patients (p<0.01). Salivary and/or lacrimal gland swelling was detected in only 50% of IgG4-SC patients (p<0.01). Endoscopic retrograde cholangiography revealed that the hilar or hepatic duct was completely obstructed in 83% of hilar CC patients (p<0.01). Lower bile duct stenosis, apart from hilar bile duct stenosis, was more frequent in IgG4-SC patients (p<0.01). Bile duct wall thickening in areas without stenosis was more frequent in IgG4-SC patients (p<0.01). CONCLUSIONS: An integrated diagnostic approach based on clinical, serological, imaging, and histological findings is necessary to differentiate IgG4-SC from hilar CC.
