Idiopathic tumefactive chronic pancreatitis: Clinical profile, histology, and natural history after resection

Dhiraj Yadav, Kenji Notahara, Thomas Christopher Smyrk, Jonathan E. Clain, Randall K. Pearson, Michael B. Farnell, Suresh T Chari

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Background & Aims: Little is known about subjects with idiopathic tumefactive chronic pancreatitis (TCP), that is, chronic pancreatitis whose clinical presentation, usually with a mass or obstructive jaundice, suggests cancer. Methods: We independently reviewed clinical data and histology of 45 TCP (27 idiopathic, 18 alcohol induced) resected at Mayo Clinic (January 1985-March 2001). Follow-up data were obtained from medical records and mailed questionnaires. Results: Compared with alcoholic subjects, idiopathic TCP patients were older (58 ± 2 vs. 48 ± 3 yr, P < 0.001), had shorter symptom duration (median 3 vs. 24 wk, P < 0.001), were more likely to have no or mild abdominal pain (70% vs. 17%, P = 0.001), and were more often jaundiced (67% vs. 33%, P = 0.02). Three distinct histologic patterns were identified in TCP. Typical CP (n = 19) showed lobular atrophy, fat necrosis, and ductal changes (dilatation, protein plugs, and stones). Lymphoplasmacytic sclerosing pancreatitis (LPSP) (n = 14) was characterized by periductal lymphoplasmacytic infiltration, obliterative phlebitis, and cholangitis with edema. Idiopathic duct-centric CP (IDCP) (n = 12) had neutrophil-predominant lobular inflammation, without phlebitis. On correlation of clinical and histologic diagnosis, 17 of 18 (94%) patients with alcohol-induced TCP had typical CP, and 25 of 27 (93%) with idiopathic TCP had LPSP or IDCP. LPSP and IDCP were indistinguishable clinically except for higher incidence of jaundice in LPSP (93% vs. 42%, P = 0.005). In idiopathic TCP no recurrence of symptoms was observed after resection (median follow-up 49 mo). Conclusions: Idiopathic TCP is clinically and histologically distinct from alcohol-induced TCP. It is unclear whether LPSP and IDCP, 2 unique patterns of histologic injury observed in idiopathic TCP, are part of the spectrum of the same disease or represent 2 or more different entities. Resection of mass prevents recurrence of symptoms in idiopathic TCP.

Original languageEnglish (US)
Pages (from-to)129-135
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume1
Issue number2
DOIs
StatePublished - Mar 1 2003

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Chronic Pancreatitis
Natural History
Histology
Pancreatitis
Phlebitis
Alcohols
Jaundice
Fat Necrosis
Recurrence
Cholangitis
Obstructive Jaundice
Alcoholics
Abdominal Pain
Atrophy
Medical Records
Dilatation
Edema
Neutrophils
Inflammation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Idiopathic tumefactive chronic pancreatitis : Clinical profile, histology, and natural history after resection. / Yadav, Dhiraj; Notahara, Kenji; Smyrk, Thomas Christopher; Clain, Jonathan E.; Pearson, Randall K.; Farnell, Michael B.; Chari, Suresh T.

In: Clinical Gastroenterology and Hepatology, Vol. 1, No. 2, 01.03.2003, p. 129-135.

Research output: Contribution to journalArticle

Yadav, Dhiraj ; Notahara, Kenji ; Smyrk, Thomas Christopher ; Clain, Jonathan E. ; Pearson, Randall K. ; Farnell, Michael B. ; Chari, Suresh T. / Idiopathic tumefactive chronic pancreatitis : Clinical profile, histology, and natural history after resection. In: Clinical Gastroenterology and Hepatology. 2003 ; Vol. 1, No. 2. pp. 129-135.
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abstract = "Background & Aims: Little is known about subjects with idiopathic tumefactive chronic pancreatitis (TCP), that is, chronic pancreatitis whose clinical presentation, usually with a mass or obstructive jaundice, suggests cancer. Methods: We independently reviewed clinical data and histology of 45 TCP (27 idiopathic, 18 alcohol induced) resected at Mayo Clinic (January 1985-March 2001). Follow-up data were obtained from medical records and mailed questionnaires. Results: Compared with alcoholic subjects, idiopathic TCP patients were older (58 ± 2 vs. 48 ± 3 yr, P < 0.001), had shorter symptom duration (median 3 vs. 24 wk, P < 0.001), were more likely to have no or mild abdominal pain (70{\%} vs. 17{\%}, P = 0.001), and were more often jaundiced (67{\%} vs. 33{\%}, P = 0.02). Three distinct histologic patterns were identified in TCP. Typical CP (n = 19) showed lobular atrophy, fat necrosis, and ductal changes (dilatation, protein plugs, and stones). Lymphoplasmacytic sclerosing pancreatitis (LPSP) (n = 14) was characterized by periductal lymphoplasmacytic infiltration, obliterative phlebitis, and cholangitis with edema. Idiopathic duct-centric CP (IDCP) (n = 12) had neutrophil-predominant lobular inflammation, without phlebitis. On correlation of clinical and histologic diagnosis, 17 of 18 (94{\%}) patients with alcohol-induced TCP had typical CP, and 25 of 27 (93{\%}) with idiopathic TCP had LPSP or IDCP. LPSP and IDCP were indistinguishable clinically except for higher incidence of jaundice in LPSP (93{\%} vs. 42{\%}, P = 0.005). In idiopathic TCP no recurrence of symptoms was observed after resection (median follow-up 49 mo). Conclusions: Idiopathic TCP is clinically and histologically distinct from alcohol-induced TCP. It is unclear whether LPSP and IDCP, 2 unique patterns of histologic injury observed in idiopathic TCP, are part of the spectrum of the same disease or represent 2 or more different entities. Resection of mass prevents recurrence of symptoms in idiopathic TCP.",
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AU - Clain, Jonathan E.

AU - Pearson, Randall K.

AU - Farnell, Michael B.

AU - Chari, Suresh T

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N2 - Background & Aims: Little is known about subjects with idiopathic tumefactive chronic pancreatitis (TCP), that is, chronic pancreatitis whose clinical presentation, usually with a mass or obstructive jaundice, suggests cancer. Methods: We independently reviewed clinical data and histology of 45 TCP (27 idiopathic, 18 alcohol induced) resected at Mayo Clinic (January 1985-March 2001). Follow-up data were obtained from medical records and mailed questionnaires. Results: Compared with alcoholic subjects, idiopathic TCP patients were older (58 ± 2 vs. 48 ± 3 yr, P < 0.001), had shorter symptom duration (median 3 vs. 24 wk, P < 0.001), were more likely to have no or mild abdominal pain (70% vs. 17%, P = 0.001), and were more often jaundiced (67% vs. 33%, P = 0.02). Three distinct histologic patterns were identified in TCP. Typical CP (n = 19) showed lobular atrophy, fat necrosis, and ductal changes (dilatation, protein plugs, and stones). Lymphoplasmacytic sclerosing pancreatitis (LPSP) (n = 14) was characterized by periductal lymphoplasmacytic infiltration, obliterative phlebitis, and cholangitis with edema. Idiopathic duct-centric CP (IDCP) (n = 12) had neutrophil-predominant lobular inflammation, without phlebitis. On correlation of clinical and histologic diagnosis, 17 of 18 (94%) patients with alcohol-induced TCP had typical CP, and 25 of 27 (93%) with idiopathic TCP had LPSP or IDCP. LPSP and IDCP were indistinguishable clinically except for higher incidence of jaundice in LPSP (93% vs. 42%, P = 0.005). In idiopathic TCP no recurrence of symptoms was observed after resection (median follow-up 49 mo). Conclusions: Idiopathic TCP is clinically and histologically distinct from alcohol-induced TCP. It is unclear whether LPSP and IDCP, 2 unique patterns of histologic injury observed in idiopathic TCP, are part of the spectrum of the same disease or represent 2 or more different entities. Resection of mass prevents recurrence of symptoms in idiopathic TCP.

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