Lymphoplasmacytic sclerosing pancreatitis: Inflammatory mimic of pancreatic carcinoma Journal Article
| Authors: | Weber, S. M.; Cubukcu-Dimopulo, O.; Palesty, J. A.; Suriawinata, A.; Klimstra, D.; Brennan, M. F.; Conlon, K. |
| Article Title: | Lymphoplasmacytic sclerosing pancreatitis: Inflammatory mimic of pancreatic carcinoma |
| Abstract: | Lymphoplasmacytic sclerosing pancreatitis (LP) is a rare cause of benign mass lesions of the pancreas that can resemble adenocarcinoma. This study evaluates and classifies a series of patients with LP. Patients with benign pancreatic disease were identified from a prospective pancreatic database, and these cases were reviewed to identify patients with LP. Patients were subdivided into two groups: (1) classic LP, which included those patients who had all four of the characteristic histologic features of LP, including lymphoplasmacytic infiltration of the pancreas, interstitial fibrosis, periductal inflammation, and periphlebitis; and (2) intermediate LP, which included patients with at least two of these histologic findings. Patient demographics, pathologic and clinical features, and outcome were analyzed. From 1985 to 2001, a total of 1287 pancreatic resections were performed at our institution, of which 159 were for benign disease. Of these, 31 had pathologic features consistent with LP, and all of these patients had a presumed preoperative diagnosis of pancreatic carcinoma. Most of these patients presented with jaundice (n = 21) or abdominal pain (n = 7). In 29 of 31 patients, curative resection was possible. Of these, 28% (8/29) developed recurrence after resection: seven with jaundice and one with recurrent pancreatitis (median time to recurrence, 11 months; median follow up, 38 months). All patients with recurrent jaundice appeared to have biliary strictures at the time of direct cholangiography and no patient had malignancy. A review of the pathology reports identified 19 patients with classic LP and 12 patients with intermediate LP, and there was no difference between these two groups. LP is a rare cause of pancreatitis that is difficult to differentiate from carcinoma preoperatively. Patients with classic and intermediate LP appear to demonstrate a similar clinical behavior. Nearly one third of patients have a progressive course after resection, with 25% developing recurrent jaundice; thus close follow-up is mandatory for all patients. © 2003 The Society for Surgery of the Alimentary Tract, Inc. |
| Keywords: | adolescent; adult; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; clinical feature; histopathology; disease classification; pancreas resection; pancreatic neoplasms; preoperative evaluation; adenocarcinoma; pancreas; demography; diagnosis, differential; differential diagnosis; inflammation; pathology; data base; abdominal pain; pancreas carcinoma; plasma cell; evaluation; pancreatitis; pancreas tumor; recurrent disease; jaundice; fibrosing alveolitis; bile duct obstruction; lymphocytic infiltration; autoimmune diseases; autoimmune disease; lymphocyte; lymphocytes; plasma cells; sclerosis; cholangiography; phlebitis; autoimmune pancreatitis; lymphoplasmacytic sclerosing pancreatitis; molecular mimicry; pancreas adenoma; humans; human; male; female; article; sclerosing pancreatitis |
| Journal Title: | Journal of Gastrointestinal Surgery |
| Volume: | 7 |
| Issue: | 1 |
| ISSN: | 1091-255X |
| Publisher: | Springer |
| Date Published: | 2003-01-01 |
| Start Page: | 129 |
| End Page: | 137 |
| Language: | English |
| DOI: | 10.1016/s1091-255x(02)00148-8 |
| PUBMED: | 12559194 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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978Klimstra
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