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KMID : 1188320130070020234
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Gut and Liver
2013 Volume.7 No. 2 p.234 ~ p.238
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Differentiating Immunoglobulin G4-Related Sclerosing Cholangitis from Hilar Cholangiocarcinoma
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Taku Tabata
Terumi Kamisawa
Seiichi Hara
Sawako Kuruma
Kazuro Chiba
Go Kuwata
Takashi Fujiwara
Hideto Egashira
Koichi Koizumi
Junko Fujiwara
Takeo Arakawa
Kumiko Momma
Masanao Kurata
Goro Honda
Koji Tsuruta
Takao Itoi
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Abstract
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Background/Aims:Few studies have differentiated immunoglobulin G (IgG) 4-related sclerosing cholangitis (IgG4-SC) from hilar cholangiocarcinoma (CC). Thus, we sought to investigate useful features for differentiating IgG4-SC from hilar CC.
Methods:We retrospectively compared clinical, serological, imaging, and histological features of six patients with IgG4-SC and 42 patients with hilar CC.
Results:In patients with hilar CC, obstructive jaundice was more frequent (p<0.01), serum total bilirubin levels were significantly higher (p<0.05), serum CA19-9 levels were significantly higher (p<0.01), and serum duke pancreatic monoclonal antigen type 2 levels were frequently elevated (p<0.05). However, in patients with IgG4-SC, the serum IgG (p<0.05) and IgG4 (p<0.01) levels were significantly higher and frequently elevated. The pancreas was enlarged in all IgG4-SC patients but only in 17% of hilar CC patients (p<0.01). Salivary and/or lacrimal gland swelling was detected in only 50% of IgG4-SC patients (p<0.01). Endoscopic retrograde cholangiography revealed that the hilar or hepatic duct was completely obstructed in 83% of hilar CC patients (p<0.01). Lower bile duct stenosis, apart from hilar bile duct stenosis, was more frequent in IgG4-SC patients (p<0.01). Bile duct wall thickening in areas without stenosis was more frequent in IgG4-SC patients (p<0.01).
Conclusions:An integrated diagnostic approach based on clinical, serological, imaging, and histological findings is necessary to differentiate IgG4-SC from hilar CC.
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KEYWORD
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Immunoglobulin G, IgG4-ralated sclerosing cholangitis, Hilar cholangiocarcinoma, Endoscopic retrograde cholangiopancreatography
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