Differential Diagnosis Between Autoimmune Pancreatitis and Pancreatic Cancer

自己免疫性膵炎は膵癌と臨床所見が類似し，かつて膵切除術が施行された症例があった．2002年に自己免疫性膵炎の診断基準が示されて以来，疾患概念が広く認知されてきたが，それでも鑑別困難な症例が存在する．自己免疫性膵炎はステロイド治療が奏功するので，不必要な手術を避けるためにも両者の鑑別が重要である．本邦を中心に本疾患の詳細な病態が報告され，集積されてきた結果，臨床所見，血液検査所見，画像所見，病理所見について膵癌との鑑別点が明らかになってきた．本邦の診断基準はステロイド投与による治療的診断を認めない立場であり，鑑別困難例に対して最終的には開腹膵生検を施行せざるをえない場合もある．病態を総合的に充分に検討し，これら鑑別点を参考にして，自己免疫性膵炎をできる限り正確に診断することが肝要である．両者の鑑別に有用と考えられるいくつかのポイントを厚生労働省難治性膵疾患調査研究班（大槻班）でまとめた．

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