Involvement of the biliary system in autoimmune pancreatitis: a follow-up study

Hirano, Keisuke; Shiratori, Yasushi; Komatsu, Yutaka; Yamamoto, Natsuyo; Sasahira, Naoki; Toda, Nobuo; Isayama, Hiroyuki; Tada, Minoru; Tsujino, Takeshi; Nakata, Rieko; Kawase, Tateo; Katamoto, Tetsuo; Kawabe, Takao; Omata, Masao

doi:10.1016/s1542-3565(03)00221-0

Cited by 156 publications

(122 citation statements)

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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: 94%

“…7 Three Japanese studies have previously examined the biliary pathology of IgG4-associated cholangitis. 12,17,18 In the largest series of 16 cases, 12 the authors distinguished five histological patterns of involvement, namely (1) portal inflammation, (2) large duct damage, (3) portal sclerosis with scarce inflammation, (4) lobular hepatitis, and (5) cholestasis. Following this scheme, the majority of our cases would be included in the portal inflammatory group with varying degrees of concurrent lobular and cholestatic patterns.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…Even in the case of short segment MPD narrowing, the upstream MPD usually does not show remarkable dilatation, a sign by which to discriminate pancreatic cancer ( Fig. 5) [39,40]. Up to 80% of AIP patients show biliary stenosis, most frequently seen in the lower part of the common bile duct, but also capable of occurring in any part of extra or intrahepatic biliary tract [36,[41][42][43].…”

Section: Endoscopic Retrograde Cholangiopancreaticographymentioning

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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“…8 As for the hepatobiliary system, although IgG4-related sclerosing cholangitis and inflammatory pseudotumors have been reported in connection with AIP, 9 it remains unclear whether other lesions are also present in the liver, as well as the prevalence of liver dysfunction in AIP patients. Additionally, beyond reports of lymphoplasmacytic infiltration with fibrosis in the portal areas 10 and infiltration of IgG4-bearing plasma cells, 11 the histopathological features in the liver remain poorly understood in AIP. It is also unknown whether these features are similar to those in the pancreas and are correlated with clinical significance.…”

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confidence: 99%