Biliary lesions associated with autoimmune pancreatitis.

Background/aims: Characteristic radiological features of biliary lesions in patients with autoimmune pancreatitis (AIP) have not yet been identified.

Methodology: Bile duct lesions and their relationships to other clinical findings were assessed in 43 AIP patients.

Results: Of the 43 AIP patients, 34 (79%) had bile duct stenosis.

Frequent and significant K-ras mutation in the pancreas, the bile duct, and the gallbladder in autoimmune pancreatitis.

Objectives: To assess the relationship between autoimmune pancreatitis (AIP) and pancreatic cancer, we analyzed K-ras mutation in the pancreatobiliary tissues of patients with AIP.

Methods: An analysis of K-ras mutation and an immunohistochemical study were performed on the pancreas of 8 patients with AIP and 10 patients with chronic alcoholic pancreatitis and on the common bile duct and the gallbladder of 9 patients with AIP. K-ras mutation was analyzed in the pure pancreatic juice from 3 patients with AIP.

Endocrine cells in ampullary carcinoma.

Background/purpose: As ampullary carcinoma originates from four anatomical regions, it may have different behaviors depending on its origin. We documented the presence of endocrine cells found in ampullary carcinoma, and we studied the clinicopathological implications of their presence.

Methods: We immunohistochemically examined the presence of an endocrine component in 62 surgically resected specimens of ampullary carcinoma, and we studied the clinicopathological differences between endocrine component-positive cases and endocrine component-negative cases.

Metachronous Carcinomas of the Biliary Tract in a Patient Treated Three Times with Curative Surgery.

We here report on a case of metachronous multicentric carcinomas of the biliary tract treated 3 times with curative surgery over 23 years. A 28-year-old woman underwent cholecystectomy because of papillary carcinoma of the gallbladder. After 17 years, 3 carcinomas developed in the biliary tract: intrahepatic cholangiocarcinoma of the left liver, common bile duct carcinoma, and remnant cystic duct carcinoma.

Biliopancreatic reflux-pathophysiology and clinical implications.

The common bile duct and the main pancreatic duct open into the duodenum, where they frequently form a common channel. The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts; it regulates the outflow of bile and pancreatic juice. In patients with a pancreaticobiliary maljunction, the action of the sphincter does not functionally affect the junction.

Serum IgG4 levels and extrapancreatic lesions in autoimmune pancreatitis.

Objective: Serum IgG4 levels are frequently elevated in patients with autoimmune pancreatitis (AIP). AIP is sometimes associated with various extrapancreatic lesions. This study examined whether there is a correlation between serum IgG4 levels and associated extrapancreatic lesions in AIP patients.

Strategy for differentiating autoimmune pancreatitis from pancreatic cancer.

Objectives: It is of utmost importance that autoimmune pancreatitis (AIP) be differentiated from pancreatic cancer (PC) because some AIP cases undergo unnecessary laparotomy or pancreatic resection on suspicion of PC. This study aimed to develop an appropriate strategy for differentiating between AIP and PC.

Methods: Clinical, serological, and radiological features of 17 AIP patients forming a masslike lesion on pancreas head and 70 patients with pancreatic head cancer were compared.

Carcinoma arising in congenital choledochal cysts.

Background/aims: Congenital choledochal cyst is almost always associated with pancreaticobiliary maljunction and is sometimes associated with biliary carcinoma. This study aimed to investigate the clinicopathological features and surgical treatment of choledochal cyst associated with carcinoma arising in the cyst wall.

Methodology: Relationship of the clinicopathological findings and surgical treatment of 8 patients with histologically proven carcinoma that had developed in the choledochal cyst wall were examined to determine mode of tumor spread, multicentric tumor origins, and coincidence with other neoplastic lesions.

IgG4-related sclerosing disease.

Based on histological and immunohistochemical examination of various organs of patients with autoimmune pancreatitis (AIP), a novel clinicopathological entity of IgG4-related sclerosing disease has been proposed. This is a systemic disease that is characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. Clinical manifestations are apparent in the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate, in which tissue fibrosis with obliterative phlebitis is pathologically induced.

A new diagnostic endoscopic tool for autoimmune pancreatitis.

Background: Autoimmune pancreatitis (AIP) is a type of pancreatitis that is presumed to have an autoimmune etiology, and is currently diagnosed based on a combination of clinical, laboratory, and imaging studies. Although it is of utmost importance that AIP be differentiated from pancreatic cancer, AIP is sometimes difficult to differentiate from locally advanced pancreatic cancer.

Objective: To find a useful new method to diagnose AIP.

Pancreas divisum in pancreaticobiliary maljunction.

Background/aims: Pancreaticobiliary maljunction (PBM) and pancreas divisum (PD) are congenital anomalies that develop in the embryo at an early stage. They are possibly the result of bile and pancreatic duct misarrangement. We investigated the configuration of the pancreatic duct in patients with PBM and its clinical implications.

Sex-based differences in gallbladder cancer associated with pancreaticobiliary maljunction.

Background/aims: Gallbladder cancer predominantly affects women; this sex-based difference is influenced by factors such as gallstones, sex hormone and genetic susceptibility. Gallbladder cancer is also frequently associated with pancreaticobiliary maljunction (PBM) without biliary dilatation. We examined sex-based differences in gallbladder cancer associated with PBM.

Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome.

Objective: Because autoimmune pancreatitis (AIP) responds well to corticosteroids, many AIP patients are given this treatment. However, there is no consensus on the indications, dose, or duration of steroid treatment. The aim of this study was to establish the most appropriate steroid therapy regimen.

Efficacy of novel hypoxic cell sensitiser doranidazole in the treatment of locally advanced pancreatic cancer: long-term results of a placebo-controlled randomised study.

Novel hypoxic cell radiosensitiser doranidazole was tested for unresectable pancreatic cancer administered at intraoperative radiotherapy. Short-term survival was not different. However, difference has been observed concerning 3-year survival (doranidazole group vs.

Pancreatographic investigation of pancreatic duct system and pancreaticobiliary malformation.

To clarify the anatomy of the pancreatic duct system and to investigate its embryology, we reviewed 256 pancreatograms with normal pancreatic head, 81 with pancreas divisum and 74 with pancreaticobiliary maljunction. Accessory pancreatograms were divided into two patterns. The long-type accessory pancreatic duct forms a straight line and joins the main pancreatic duct at the neck portion of the pancreas.

Rectal cancer metastasis to the head of the pancreas treated with pancreaticoduodenectomy.

We report a case of a 50-year-old man who developed metastatic pancreatic cancer from a primary rectal cancer that had been curatively removed 3 years previously. The patient presented with a tumor that occupied the head of the pancreas, associated with obstructive jaundice, but the main pancreatic duct was not dilated. The patient was initially diagnosed as having primary pancreatic cancer.

The incidence of pancreatic and extrapancreatic cancers in Japanese patients with chronic pancreatitis.

Background/aims: Although an association between chronic pancreatitis and malignancies has been reported in the Western literature, in Japan there have been few reports that have dealt with this issue. We investigated the incidence of pancreatic and extrapancreatic cancers in Japanese patients with chronic pancreatitis.

Methodology: We studied 170 Japanese patients with definite chronic pancreatitis with respect to the occurrence of pancreatic and extrapancreatic cancers during follow-up and compared the incidence with that reported in the Western literature.

Tumor size significantly correlates with postoperative liver metastases and COX-2 expression in patients with resectable pancreatic cancer.

Background/aim: Local treatment often fails in patients with resectable pancreatic cancer due to the postoperative development of distant metastases, especially liver metastases. We determined the prognostic factors for postoperative liver metastases in pancreatic cancer patients following surgical resection with combined radiotherapy.

Methods: Sixty-four patients with nonmetastatic, resectable pancreatic cancer were entered into this study.

Prognosis of autoimmune pancreatitis.

Autoimmune pancreatitis (AIP) is responsive to steroid therapy, but some AIP patients improve spontaneously, or only improve after biliary drainage. Pancreatic enlargement and irregular narrowing of the main pancreatic duct usually improves in almost all patients, but marked atrophy of the pancreas develops in some patients. Biliary stenosis improves to various degrees, and a biliary drainage tube can be withdrawn.

[Low-dose gemcitabine concurrent with radiation therapy for locally advanced pancreatic carcinoma].

We evaluated the efficacy and feasibility of low-dose gemcitabine concurrent with radiation as adjuvant therapy. Nine cases of locally far advanced unresectable pancreatic cancer were enrolled in this study. Intraoperative radiation was carried out in every case using eight or ten centimeter cones with a radiation dose of twenty to twenty five Gy.

Pancreatographic investigation of embryology of complete and incomplete pancreas divisum.

Objectives: To investigate embryology of complete and incomplete pancreas divisum (PD).

Methods: We analyzed anatomy of the pancreatic duct system in 44 cases of complete PD and 41 cases of incomplete PD. Under the concept of branch fusion between the ventral and dorsal pancreatic ducts, incomplete PD was divided into 3 types: fusion of the extreme end of the upper branch of the ventral pancreatic duct with the dorsal pancreatic duct (type 1); fusion of the lower branch of the dorsal pancreatic duct with the lower branch of the ventral pancreatic duct (type 2); and fusion of the lower branch of the dorsal pancreatic duct with the ventral pancreatic duct (type 3).

Comparison of radiological and histological findings in autoimmune pancreatitis.

Background/aims: Autoimmune pancreatitis displays radiological findings that are sometimes difficult to differentiate from pancreatic carcinoma. To understand the essential radiological features of autoimmune pancreatitis (AIP), we compared imaging and histological findings in resected AIP specimens.

Methodology: Findings of ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography and angiography were examined retrospectively for 6 patients who underwent pancreatoduodenectomy on suspicion of pancreatic carcinoma, and compared with histological findings of the resected specimens.

Biliary carcinoma risk in patients with pancreaticobiliary maljunction and the degree of extrahepatic bile duct dilatation.

Background/aims: Pancreaticobiliary maljunction (PBM) carries a high risk of biliary carcinoma. This study aimed to examine the biliary complications of patients with PBM in relation to the degree of extra-hepatic bile duct dilatation.

Methodology: Ninety-eight cases of PBM could be divided into 5 groups according to the maximum diameter of the extrahepatic bile duct: < or = 10mm, 11-15mm, 16-20mm, 21-30mm, > or = 31mm.

Pancreatic cancer with a high serum IgG4 concentration.

Differentiation between autoimmune pancreatitis and pancreatic cancer is sometimes difficult. It has been reported that serum IgG4 concentrations are significantly elevated and particularly high (>135 mg/dL) in autoimmune pancreatitis. Measurement of serum IgG4 has become a useful tool for differentiating between autoimmune pancreatitis and pancreatic cancer.

Acute pancreatitis and a long common channel.

Background: As sphincter action does not functionally affect the union in pancreaticobiliary maljunction (PBM), two-way regurgitation occurs. We investigated the features of acute pancreatitis associated with patients displaying a long common channel.

Methods: We reviewed 3210 endoscopic retrograde cholangiopancreatograms.