Shuji Seko

High Prevalence of Autoantibodies Against Carbonic Anhydrase II and Lactoferrin in Type 1 Diabetes : Concept of Autoimmune Exocrinopathy and Endocrinopathy of the Pancreas

Introduction Dysfunction of the exocrine as well as the endocrine pancreas has been reported in type 1 diabetes. Lymphocytic infiltration of the exocrine pancreas is observed in approximately half of Japanese type 1 diabetic patients. Aims To investigate the involvement of autoimmunity against the exocrine pancreas in type 1 diabetes. Methodology We examined autoantibodies against human carbonic anhydrase II (ACA) and lactoferrin (ALF), antigens in the pancreatic duct cells and the pancreatic acinus, respectively, in 43 type 1 diabetic patients and 20 type 2 diabetic patients using the enzyme-linked immunosorbent assay method. Results Of 43 type 1 diabetic patients, ACA was detected in 28 patients (65%) and ALF was detected in 29 patients (67%). One or both of the antibodies were detected in 33 type 1 diabetic patients (77%). In contrast, neither ACA nor ALF were detected in type 2 diabetic patients. Conclusions The high prevalence of both ACA and ALF strongly suggests the involvement of autoimmunity against the exocrine pancreas as well as the endocrine pancreas in some type 1 diabetic patients. We propose that these conditions be referred to as autoimmune exocrinopathy and endocrinopathy of the pancreas.

Autoimmune pancreatitis detected as a mass in the tail of the pancreas

A mass in the tail of the pancreas was detected in a 62‐year‐old male patient who had hypergammaglobulinaemia, and was positive for antinuclear antigen and anti‐SS‐A antibody. Endoscopic retrograde pancreatography revealed focal irregular narrowing of the main pancreatic duct in the tail of the pancreas. Dynamic computed tomography showed swelling of the pancreatic tail, which was enhanced on delayed phase. Autoimmune pancreatitis was suspected and corticosteroid therapy was commenced. This led to significant resolution of the pancreatic stricture. It is important to recognize this clinical entity as corticosteroid therapy may avoid unnecessary surgery.

Autoimmune pancreatitis detected as a mass in the head of the pancreas without hypergammaglobulinemia, which relapsed after surgery: case report and review of the literature.

Autoimmune pancreatitis is a recently proposed clinical entity characterized by diffuse swelling of the pancreas, irregular narrowing of the main pancreatic duct on endoscopic retrograde pancreatography, hypergammaglobulinemia, and the presence of autoantibodies, together with responsiveness to corticosteroid therapy (1, 2). There are some reports of cases with focal swelling, which simulates pancreatic cancer or lymphoma (3–6), as well as cases that begin with focal swelling and progress to diffuse swelling (7–10 ). Here, we report a case of autoimmune pancreatitis that presented with obstructive jaundice and a mass in the head of the pancreas, which progressed to diffuse swelling 4 months after surgery. We also review the clinical features of reported cases of autoimmune pancreatitis.

CASE REPORT: Autoimmune Pancreatitis Detected as a Mass in the Head of the Pancreas with Contiguous Fibrosis Around the Superior Mesenteric Artery

Several cases of chronic pancreatitis associated with autoimmunity have been reported (1–3), and the concept of autoimmune pancreatitis was recently proposed (4, 5). This clinical entity is characterized by diffuse or focal swelling of the pancreas, irregular narrowing of the main pancreatic duct on endoscopic retrograde pancreatography (ERP), hypergammaglobulinemia, and the presence of autoantibodies, together with remarkable responsiveness to corticosteroid therapy. Some cases showing focal swelling or multiple focal masses that simulate pancreatic cancer or lymphoma have been reported by us and others (3, 6–10). Here, we report a case of autoimmune pancreatitis, detected as a mass in the head of the pancreas with a contiguous mass around the superior mesenteric artery, that was treated successfully with corticosteroid.