Autoimmune pancreatitis

Abstract

Pathologically, AIP shows narrowing of the pancreatic ducts and the intrapancreatic portion of the common bile duct. Obstructive jaundice is a common symptom at presentation, and pancreatic cancer represents an important clinical differential diagnosis. In late stages of the disease, the normal pancreatic parenchyma is often replaced by large amounts of fibrosis. Histologically, there seem to be two subtypes of the disease-one showing infiltration with IgG4-positive plasma cells but lacking granulocytic epithelial lesions (GELs), the other showing GELs but lacking strong IgG4 positivity. AIP is in at least some instances the pancreatic manifestation of a clinicopathological entity of IgG4-related systemic sclerosing disease. On the basis of pancreatic imaging, together with serological measurement of IgG4 and evaluation of other organ involvement, many AIP patients can be identified. The remaining patients require further diagnostic work-up. In these patients, pancreatic core needle biopsy and, as AIP responds to steroid treatment, also a trial with steroids, can help to differentiate AIP from pancreatic cancer. OUTLOOK AND DISCUSSION: This review presents the pathological, radiologic and laboratory findings of AIP. Moreover, the treatment and pathogenesis are discussed.

Autoimmune Pancreatitis in Hungary: A Multicenter Nationwide Study

“…In agreement with previous reports [1,3,6,7,19], rapid symptomatic response and improvements in liver biochemistry and morphology were observed 4 weeks after the start of steroid therapy. However, in contrast to the earlier reports, recurrence was rarely encountered.…”

“…Certain histological features in the pancreas are diagnostic of AIP [1,15]. Eight of our patients exhibited a discrete mass in the pancreas.…”

“…The characteristics of the disease have been described in detail in excellent reviews [1,2,3,4,5]. Most cases of AIP have been reported from Japan.…”

Autoimmune Pancreatitis: An Autoimmune or Immunoinflammatory Disease?

“…Autoimmune pancreatitis is a rare systemic fibrotic inflammatory disorder of the pancreas associated with unique clinical and histopathological characteristics, family history of autoimmune diseases, presence of autoantibodies, presence of IgG4+ cells in duodenal and pancreatic biopsy tis-sues, elevated serum IgG4, and response to corticosteroids [15][16][17][18][19][20][21]. The fibrotic inflammatory process can also affect organs such as the bile ducts, salivary glands, and retroperitoneal lymph nodes.…”

Unnecessary Procedures and Surgery in Autoimmune Pancreatitis

“…Diagnostic work-up is initiated mostly for unexplained symptoms of chronic pancreatitis or persistently elevated cholestatic blood values. The most typical finding on diagnostic imaging is a diffusely or tumour-like enlarged pancreas, with pancreatic calcification or pseudocysts seen rarely [7,8] . Other abnormalities have been detected in imaging studies of patients with symptoms similar to those of chronic pancreatitis.…”