纤维包块型胰腺炎的临床及病理特征

Clinicopathologic characteristics of fibrous mass-forming chronic pancreatitis

目的 研究纤维包块型胰腺炎（FMCP）,探讨自身免疫性胰腺炎（AIP）和纤维包块形成的非AIP（nAIP）的临床和病理学差异及免疫组织化学特征,为二者的病理诊断和鉴别诊断及临床治疗方案提供依据.方法 对收集于2004至2010年的81例FMCP进行组织学及临床病理特征分析,采用免疫组织化学染色计数IgG4＋浆细胞.结果 81例FMCP中符合AIP者为20例,nAIP为61例.AIP好发于50岁以上男性,nAIP则好发于50岁以下男性（P =0.001）.AIP中间质炎性细胞的浸润较nAIP中更加显著（P =0.002）；AIP神经炎的发生率（100％,20/20）明显高于nAIP（75.4％,46/61；P=0.017）；席纹状纤维化在AIP（95.0％,19/20）中比在nAIP（1.6％,1/61）中更常见（P=0.000）；胰腺导管上皮内瘤变（PanIN）的发生率分别为50.0％ （10/20）和32.8％ （20/61）,AIP中PanIN的程度更重（P=0.031）；导管复合体（TC）在AIP（65.0％,13/20）中比在nAIP（26.2％,16/61）中更常见（P =0.002）.81例FMCP病例中,61例＜11个IgG4＋浆细胞/高倍镜视野（HPF）,7例介于（11 ～30）个/HPF,13例＞30个/HPF.结论 纤维包块形成性胰腺炎包括AIP和nAIP,AIP具有一定的病理形态特征,IgG4＋浆细胞是AIP的一个重要诊断指标.FMCP中PanIN和TC均有较高的发生率,可能是胰腺导管腺癌重要的癌前病变.临床上FMCP常因胰腺占位与胰腺癌难以鉴别而进行手术治疗,但其中AIP对激素治疗有良好反应性,因此AIP的准确及时诊断具有更重要的临床意义,不仅能避免不必要的手术,而且有助于早期合理治疗,防止病情进展.

Objective To investigate clinicopathological features of fibrous mass-forming chronic pancreatitis （FMCP）, to compare efinicopathological and immunohistoehemical characteristics between autoimmune pancreatitis （AIP） and fibrous mass-forming non-autoimmune pancreatitis （nAIP） and to provide evidence for pathological diagnosis, differential diagnosis and clinical treatment strategy. Methods Clinicopathological features were analyzed in 81 cases of FMCP. Infiltrating IgG4 ~ plasmacytes were counted by immunohistochemieal staining. Results Among 81 cases of FMCP, 20 cases were diagnosed as AlP and 61 cases were interpreted as nAIP. AIP was more common in males over 50 years, whereas nAIP was seen in much younger patients （ P = 0. 001 ）. The amount of inflammatory cells in the stroma of AIPs was remarkable higher than that in nAIPs （P =0. 002）. The incidence of neuritis in AIPs （100% ,20/20） was also higher compared with that of nAIPs （ 75.4% ,46/61 ; P = 0. 017 ）. Storiformed-fibrosis was more common in AIPs （95.0%, 19/20） than in nAIPs （ 1.6%, 1/61 ;P =0. 000）. Pancreatic intraepithelial neoplasia （PanIN） was observed in 50. 0% （10/20） of AIPs and 32. 8% （20/61） of nAIPs, with a greater severity observed in AIPs （P =0. 031 ）. Tubular complex （TC） was more commonly observed in AIPs （65.0%, 13/20） than nAIPs （26.2%, 16/61;P = 0.002）. Among 81 cases of F},ICP, 61 cases had less than 11 IgG4~ plasmacytes/HPF, 7 cases had 10-30/HPF and 13 cases had over 30/HPF. Conclusions FMCPs include both AIP and nAIP. AIP has distinct pathological features and the presence of IgG4＋ plasmaeyte is an important diagnostic parameter. FMCP appears to be an important precancerous lesion of pancreatic ductal adenocareinoma. Surgery may be considered for patients with FMCP due to its mass-forming nature. In contrast, patients with AlP are trealed medically due loils steroid-responsiveness. Therefore, accurate and timely diagnosis of AlP is of clinical relevance to avoid u,meeessal7 surgical complications and to prevent progression of the disease.