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AIM:To investigate differences in clinical features between diffuse-and focal-type autoimmune pancreatitis(AIP).METHODS:Based on radiological findings by computed tomography and/or magnetic resonance imaging,we divided 67 AIP patients into diffuse type(D type) and focal type(F type).We further divided F type into head type(H type) and body and/or tail type(B/T type) according to the location of enlargement.Finally,we classified the 67 AIP patients into three groups:D type,H type and B/T type.We compared the three types of AIP in terms of clinical,laboratory,radiological,functional and histological findings and clinical course.RESULTS:There were 34 patients with D-type,19 with H-type and 14 with B/T-type AIP.Although obstructive jaundice was frequently detected in D-typepatients(88%) and H-type patients(68%),no B/T-type patients showed jaundice as an initial symptom(P < 0.001).There were no differences in frequency of abdominal pain,but acute pancreatitis was associated more frequently in B/T-type patients(36%) than in D-type patients(3%)(P = 0.017).Serum immunoglobulin G(IgG)4 levels were significantly higher in D-type patients(median 309 mg/dL) than in B/T-type patients(133.5 mg/dL)(P = 0.042).Serum amylase levels in B/T-type patients(median:114 IU/L) were significantly greater than in H-type patients(72 IU/L)(P = 0.049).Lymphoplasmacytic sclerosing pancreatitis(LPSP) was histologically confirmed in 6 D-type,7 H-type and 4 B/T-type patients;idiopathic duct-centric pancreatitis was observed in no patients.Marked fibrosis and abundant infiltration of CD20-positive B lymphocytes with few IgG4-positive plasma cells were detected in 2 B/T-type patients.Steroid therapy was effective in all 50 patients(31 D type,13 H type and 6 B/T type).Although AIP relapsed during tapering or after stopping steroids in 3 D-type and 3 H-type patients,no patients relapsed in B/T type.During follow-up,radiological features of 6 B/T-type patients were not changed and 1 B/T-type patient improved naturally.CONCLUSION:Clinical features of H-type AIP were similar to those of D-type,but B/T-type differed from D and H types.B/T-type may involve diseases other than LPSP.
AIM: To investigate differences in clinical features between diffuse-and focal-type autoimmune pancreatitis (AIP). METHODS: Based on radiological findings by computed tomography and / or magnetic resonance imaging, we divided 67 AIP patients into diffuse type (D type) and focal type (F type) .We further divided F type into head type (H type) and body and / or tail type (B / T type) according to the location of enlargement. : D type, H type and B / T type. We compared the three types of AIP in terms of clinical, laboratory, radiological, functional and histological findings and clinical course .RESULTS: There were 34 patients with D-type, 19 with H -type and 14 with B / T-type AIP. Although obstructive jaundice was frequently detected in D-type patients (88%) and H-type patients (68%), no B / T-type patients showed jaundice as an initial symptom P <0.001) .here were no differences in frequency of abdominal pain, but acute pancreatitis was associated more frequently Serum immunoglobulin G (IgG) 4 levels were significantly higher in D-type patients (median 309 mg / dL) than in D-type patients (36% Serum amylase levels in B / T-type patients (median: 114 IU / L) were significantly greater than in H-type patients (72 IU (133.5 mg / dL) / L) (P = 0.049). Lymphoplasmacytic sclerosing pancreatitis (LPSP) was identified as 6 D-type, 7 H-type and 4 B / T-type patients; idiopathic duct-centric pancreatitis was observed in no patients. and abundant infiltration of CD20-positive B lymphocytes with few IgG4-positive plasma cells were detected in 2 B / T-type patients. Steroid therapy was effective in all 50 patients (31 D type, 13 H type and 6 B / T type) .Although AIP relapsed during tapering or after stopping steroids in 3 D-type and 3 H-type patients, no patients relapsed in B / T type. Fluid follow-up, radiological features of 6 B / T-type patients were not changed and 1 B / T-type patient improved naturally. CONCLUSION: Clinical features of H-type AIP were similar to those of D-type, but B / T-type differed from D and H types. B / T-type may involve diseases other than LPSP.