Cargando…
Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma
BACKGROUND AND AIM: Immunoglobulin G4-associated cholangitis (IAC) shares many similar symptoms with cholangiocarcinoma (CCA). However, the treatment and the prognosis are substantially different. This study aimed to identify the important markers for the differential diagnosis of these 2 diseases....
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health, Inc
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900416/ https://www.ncbi.nlm.nih.gov/pubmed/26974756 http://dx.doi.org/10.1097/MCG.0000000000000509 |
_version_ | 1782436632185536512 |
---|---|
author | Du, Shunda Liu, Gang Cheng, Xinqi Li, Yue Wang, Qian Li, Ji Lu, Xin Zheng, Yongchang Xu, Haifeng Chi, Tianyi Zhao, Haitao Xu, Yiyao Sang, Xinting Zhong, Shouxian Mao, Yilei |
author_facet | Du, Shunda Liu, Gang Cheng, Xinqi Li, Yue Wang, Qian Li, Ji Lu, Xin Zheng, Yongchang Xu, Haifeng Chi, Tianyi Zhao, Haitao Xu, Yiyao Sang, Xinting Zhong, Shouxian Mao, Yilei |
author_sort | Du, Shunda |
collection | PubMed |
description | BACKGROUND AND AIM: Immunoglobulin G4-associated cholangitis (IAC) shares many similar symptoms with cholangiocarcinoma (CCA). However, the treatment and the prognosis are substantially different. This study aimed to identify the important markers for the differential diagnosis of these 2 diseases. METHODS: Thirty IAC patients and 275 CCA patients were reviewed retrospectively for their clinical symptoms, serological tests, and imaging characteristics. Posttreatment responses were also studied. RESULTS: IgG4 had 100% specificity for IAC at a cutoff of 6 times the upper normal limit. IAC patients had a significantly higher incidence of weight loss (P=0.025) and a higher level of weight loss (P=0.008) than CCA patients. The positive rates of biological markers CA199, CA242, and CEA in CCA and IAC were 81.5% versus 42.9%, 45.5% versus 4.5%, and 29.2% versus 7.1%, respectively. Levels of these tumor markers in CCA were significantly higher than in IAC (P<0.05). The thickened wall [17/18 (94.4%) vs. 3/10 (30%), P=0.001] and the occupying lesion on the bile duct [1/18 (5.6%) vs. 8/10 (80%), P<0.001] were found to be significantly different in IAC and CCA, respectively, by endoscopic ultrasonography. Autoimmune pancreatitis was the most frequently observed comorbidity of IAC (25/30). All IAC patients respond positively to steroid treatment. CONCLUSIONS: Increased tumor markers, 6-fold higher levels of serum IgG4, and other organs’ involvement could be the reference factors for a differential diagnosis of IAC and CCA. Endoscopic ultrasonography might be an effective imaging tool for diagnosis, although clinical signs and symptoms of IAC and CCA are similar. Experimental steroid treatment can be useful in the diagnosis for certain difficult cases. |
format | Online Article Text |
id | pubmed-4900416 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health, Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-49004162016-06-28 Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma Du, Shunda Liu, Gang Cheng, Xinqi Li, Yue Wang, Qian Li, Ji Lu, Xin Zheng, Yongchang Xu, Haifeng Chi, Tianyi Zhao, Haitao Xu, Yiyao Sang, Xinting Zhong, Shouxian Mao, Yilei J Clin Gastroenterol LIVER, PANCREAS AND BILIARY TRACT: Original Articles BACKGROUND AND AIM: Immunoglobulin G4-associated cholangitis (IAC) shares many similar symptoms with cholangiocarcinoma (CCA). However, the treatment and the prognosis are substantially different. This study aimed to identify the important markers for the differential diagnosis of these 2 diseases. METHODS: Thirty IAC patients and 275 CCA patients were reviewed retrospectively for their clinical symptoms, serological tests, and imaging characteristics. Posttreatment responses were also studied. RESULTS: IgG4 had 100% specificity for IAC at a cutoff of 6 times the upper normal limit. IAC patients had a significantly higher incidence of weight loss (P=0.025) and a higher level of weight loss (P=0.008) than CCA patients. The positive rates of biological markers CA199, CA242, and CEA in CCA and IAC were 81.5% versus 42.9%, 45.5% versus 4.5%, and 29.2% versus 7.1%, respectively. Levels of these tumor markers in CCA were significantly higher than in IAC (P<0.05). The thickened wall [17/18 (94.4%) vs. 3/10 (30%), P=0.001] and the occupying lesion on the bile duct [1/18 (5.6%) vs. 8/10 (80%), P<0.001] were found to be significantly different in IAC and CCA, respectively, by endoscopic ultrasonography. Autoimmune pancreatitis was the most frequently observed comorbidity of IAC (25/30). All IAC patients respond positively to steroid treatment. CONCLUSIONS: Increased tumor markers, 6-fold higher levels of serum IgG4, and other organs’ involvement could be the reference factors for a differential diagnosis of IAC and CCA. Endoscopic ultrasonography might be an effective imaging tool for diagnosis, although clinical signs and symptoms of IAC and CCA are similar. Experimental steroid treatment can be useful in the diagnosis for certain difficult cases. Wolters Kluwer Health, Inc 2016-07 2016-06-08 /pmc/articles/PMC4900416/ /pubmed/26974756 http://dx.doi.org/10.1097/MCG.0000000000000509 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivative License, 4.0 (CCBY-NC-ND) which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0. |
spellingShingle | LIVER, PANCREAS AND BILIARY TRACT: Original Articles Du, Shunda Liu, Gang Cheng, Xinqi Li, Yue Wang, Qian Li, Ji Lu, Xin Zheng, Yongchang Xu, Haifeng Chi, Tianyi Zhao, Haitao Xu, Yiyao Sang, Xinting Zhong, Shouxian Mao, Yilei Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma |
title | Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma |
title_full | Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma |
title_fullStr | Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma |
title_full_unstemmed | Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma |
title_short | Differential Diagnosis of Immunoglobulin G4-associated Cholangitis From Cholangiocarcinoma |
title_sort | differential diagnosis of immunoglobulin g4-associated cholangitis from cholangiocarcinoma |
topic | LIVER, PANCREAS AND BILIARY TRACT: Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900416/ https://www.ncbi.nlm.nih.gov/pubmed/26974756 http://dx.doi.org/10.1097/MCG.0000000000000509 |
work_keys_str_mv | AT dushunda differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT liugang differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT chengxinqi differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT liyue differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT wangqian differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT liji differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT luxin differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT zhengyongchang differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT xuhaifeng differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT chitianyi differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT zhaohaitao differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT xuyiyao differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT sangxinting differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT zhongshouxian differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma AT maoyilei differentialdiagnosisofimmunoglobuling4associatedcholangitisfromcholangiocarcinoma |