{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 26, Ep 3 of 5: Autoimmune Pancreatitis Types One and Two","html":"","width":"100%","height":180,"duration":462,"description":"Episode three steps outside the alcohol-and-tobacco gland to a diagnosis that sits at a costly decision point: steroids given to a patient who actually has adenocarcinoma cost the curative resection window. Autoimmune pancreatitis splits on mechanism, type one a systemic IgG4-related plasma-cell disease of older men with painless jaundice, type two a duct-centered process a decade younger tied to inflammatory bowel disease. Demographics, imaging, serology, other-organ involvement, and histology all line up behind that one distinction, and the criteria are structured precisely because the mass mimics cancer. The steroid trial is pulled in as a diagnostic element, but when the differential with adenocarcinoma stays genuinely unresolved, surgery comes first. Mechanism drives the whole call.\n \nTopics covered\n\nMechanism split: plasma-cell versus duct-centered\nDemographics of type one and type two\nImaging and the absent double-duct sign\nIgG4 serology and its threshold\nOther-organ involvement\nHistology: storiform fibrosis versus granulocytic lesion\nSteroid response as a diagnostic element\nWhen surgery precedes the steroid trial\nRelapse pattern and rituximab\n \n \nKey decisions\n\nType one is a systemic IgG4-related plasma-cell disease of older men presenting with painless obstructive jaundice, while type two is a duct-centered process a decade younger with an even sex distribution and an inflammatory bowel disease association in about a third.\nAdenocarcinoma produces the double-duct sign with upstream dilation, whereas type one infiltrates and narrows the duct without dilating it, so a sausage-shaped gland with a capsule rim and a non-dilated duct nearly makes the diagnosis.\nA mild IgG4 elevation under twofold also occurs in some pancreatic cancers, so only a value greater than two times the upper limit of normal supports autoimmune pancreatitis, and even then it is one criterion among several.\nBoth types respond to prednisone forty milligrams daily for four weeks then a...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}