Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis

Nakazawa, Takahiro; Ohara, Hirotaka; Sano, Hitoshi; Aoki, Shigeru; Kobayashi, Shinya; Okamoto, Tetsu; Imai, Hideto; Nomura, Tomoyuki; Joh, Takashi; Itoh, Makoto

doi:10.1016/s0016-5107(04)02229-1

Cited by 233 publications

(205 citation statements)

References 20 publications

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“…12 Middle bile duct stricture co-occurred with lower bile duct stricture in cholangiography for 4 cases. Thus, stenotic change in 4 middle bile duct cases appeared to share a common mechanism of IgG4-related biliary wall inflammation with lower bile duct stricture, suggesting that simultaneous lower bile duct stricture and middle bile duct stricture represents dominant IgG4-related bile 16 duct inflammation. In addition, 2 patients with neither pancreatic swelling nor pancreatic duct stricture in the head region may exhibit IgG4-related bile duct inflammation as a dominant factor in lower bile duct stricture (Figure 4).…”

Section: Discussionmentioning

confidence: 93%

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Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Watanabe

Maruyama²,

Ito³

et al. 2014

Pancreas

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ObjectivesWe attempted to clarify the mechanism underlying lower bile duct stricture in autoimmune pancreatitis. MethodsImaging and histology of the bile duct were assessed for 73 patients with autoimmune pancreatitis to clarify whether IgG4-related biliary inflammation or pancreatic head swelling is associated with lower bile duct stricture. ResultsLower bile duct stricture was found in 59 patients (81%). Pancreatic head swelling was significantly more frequent among patients with lower bile duct stricture than those without (53 (90%) versus 4 (29%); p<0.01). Intraductal ultrasonography revealed lower bile duct wall thickening in 21 of 22 patients with lower bile duct stricture (95%), and lower bile duct wall of patients with pancreatic head swelling was significantly thicker than those without (p=0.028). Among 38 patients with lower bile duct biopsies, 14 (37%) exhibited abundant IgG4-bearing plasma cell infiltration. Among lower bile duct 4 stricture patients, an IgG4-related inflammation seemed to exert a dominant effect under limited conditions, including concomitant middle bile duct stricture and neither pancreatic swelling nor pancreatic duct stricture in the head region. ConclusionsBoth pancreatic head swelling and IgG4-related biliary inflammation influence the occurrence of lower bile duct stricture, which may be included in IgG4-related sclerosing cholangitis. Pancreatic head swelling affects IgG4-related biliary wall thickening.

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Section: Discussionmentioning

confidence: 93%

“…The present study aimed to resolve this issue by analyzing cholangiography, IDUS, and computed tomography (CT), and bile duct histology findings. 16 …”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Watanabe

Maruyama²,

Ito³

et al. 2014

Pancreas

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“…Several recent series have described the hepatic manifestations of IgG4-associated cholangitis. 7,[13][14][15][16][17] The involvement of large bile ducts is characterized by a dense transmural inflammatory infiltrate resembling that observed in the pancreas. 7 Three Japanese studies have previously examined the biliary pathology of IgG4-associated cholangitis.…”

Section: Discussionmentioning

confidence: 93%

“…6 However, although it has been reported by some that imaging studies may help segregate IgG4-associated cholangitis from primary sclerosing cholangitis, in our experience we were unable to make this distinction. 13 We report that some morphological features may allow the distinction of primary sclerosing cholangitis from IgG4-associated cholangitis. The IgG4-associated cholangitis liver samples presented with a dense inflammatory infiltrate that is not only Study on IgG4-associated cholangitis V Deshpande et al portal based but also involve the lobules with the occasional involvement of zone 3.…”

Section: Discussionmentioning

confidence: 95%

IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material

et al. 2009

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IgG4-associated cholangitis is a steroid-responsive hepatobiliary inflammatory condition associated with autoimmune pancreatitis that clinically and radiologically mimics primary sclerosing cholangitis. In this study, we conducted a morphological and immunohistochemical analysis of liver material obtained from individuals with IgG4-associated cholangitis, and compared these with well-characterized cases of primary sclerosing cholangitis. The study group consisted of 10 patients (9 biopsy and 1 hepatectomy case) with IgG4-associated cholangitis and 17 patients with primary sclerosing cholangitis (16 needle biopsy and 1 hepatectomy case). All patients with IgG4-associated cholangitis had pancreatic involvement as well, and six pancreatectomy samples revealed characteristic histopathological features of autoimmune pancreatitis. Primary sclerosing cholangitis cases were defined by the presence of a characteristic ERCP appearance. Clinical, pathological, radiological, and follow-up data were recorded for all cases. Portal and periportal inflammation was graded according to Ishak's guidelines. Immunohistochemical stains for IgG and IgG4 were performed. The cohort of patients with IgG4-associated cholangitis (mean age: 63 years) was older than individuals with primary sclerosing cholangitis (mean age: 44 years). Seven of these cases showed intrahepatic biliary strictures. IgG4-associated cholangitis liver samples showed higher portal (P ¼ 0.06) and lobular (P ¼ 0.009) inflammatory scores. Microscopic portal-based fibro-inflammatory nodules that were composed of fibroblasts, plasma cells, lymphocytes, and eosinophils were exclusively observed in five of the IgG4-associated cholangitis cases (50%). More than 10 IgG4-positive plasma cells per HPF (high power field) were observed in 6 of the IgG4-associated cholangitis cases (mean: 60, range: 0-140 per HPF), whereas all primary sclerosing cholangitis cases showed significantly lesser numbers (mean: 0.08, range: 0-1 per HPF). On a liver biopsy, the histological features of IgG4-associated cholangitis may be distinctive, and in conjunction with IgG4 immunohistochemical stain, may help distinguish this disease from primary sclerosing cholangitis.

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“…These clinical features suggest a resemblance to Mikulicz disease. Concerning sclerosing cholangitis with AIP, Nakazawa et al [84,85] reported that it shows some differences in the cholangiographic findings from PSC.…”

Section: Extrapancreatic Organ Involvementmentioning

confidence: 99%

Autoimmune pancreatitis in Japan: overview and perspective

Shimosegawa

Kanno

2009

J Gastroenterol

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Since the rediscovery and definition of autoimmune pancreatitis (AIP) by Yoshida et al. in 1995, the disease has been attracting attention because of its unique clinical features and practical issues. This disease shows very impressive imaging findings, serological changes, and characteristic histopathology. It occurs most commonly in elderly males with painless jaundice or mild abdominal pain; resemblance in imaging findings between AIP and pancreatobiliary cancers poses an important practical issue of differentiation. With increasing recognition of AIP and accumulation of cases, another important feature of this disease has been revealed, i.e

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Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis

Cited by 233 publications

References 20 publications

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

Mechanisms of Lower Bile Duct Stricture in Autoimmune Pancreatitis

IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material

Autoimmune pancreatitis in Japan: overview and perspective

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