Lymphoplasmacytic granuloma localized to the ampulla of Vater: an ampullary lesion of IgG4-related systemic disease?

Hisa, Takeshi; Ohkubo, Hiroki; Shiozawa, Satoshi; Ishigame, Hiroki; Furutake, Masayuki; Takamatsu, Masato

doi:10.1016/j.gie.2008.02.079

Cited by 8 publications

(2 citation statements)

References 11 publications

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“…Supplemental endoscopic biopsy samples taken from the ampulla of Vater are useful for differential diagnosis of IgG4‐SC from PSC ; however, endoscopic biopsy histopathology itself should not be relied on for final diagnosis of IgG4‐related diseases. One case report described isolated‐type IgG4‐related disease of the ampulla of Vater . Although there are no consensus diagnostic criteria available regarding the ampulla of Vater in IgG4‐related disease, it could be considered in diagnosis if there are typical endoscopic findings such as swollen ampulla of Vater associated with hooding‐fold bulging and biopsy histopathologic results indicating infiltration with abundant IgG4‐positive plasma cells .…”

Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

121

143

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IgG4‐related sclerosing cholangitis (IgG4‐ SC ) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4‐related disease. Although clinical diagnostic criteria of IgG4‐ SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4‐ SC are available. Because the evidence level of most articles retrieved through searching the PubMed, Cochrane Library, and Igaku Chuo Zasshi databases was below C based on the systematic review evaluation system of clinical practice guidelines MINDS 2014, we developed consensus guidelines using the modified Delphi approach. Three committees (a guideline creating committee, an expert panelist committee for rating statements according to the modified Delphi method, and an evaluating committee) were organized. Eighteen clinical questions ( CQ s) with clinical statements were developed regarding diagnosis (14 CQ s) and treatment (4 CQ s). Recommendation levels for clinical statements were set using the modified Delphi approach. The guidelines explain methods for accurate diagnosis, and safe and appropriate treatment of IgG4‐ SC .

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Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for IgG4‐related sclerosing cholangitis

Kamisawa

Nakazawa

Tazuma

et al. 2019

J Hepato Biliary Pancreat

121

143

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“…The authors additionally reported a study of HLA-DR-antigen expression regarding the duodenal papilla. Hisa and colleagues presented an interesting case with lymphoplasmacytic granuloma localized only in the duodenal papilla which was positively immunostained for IgG4 and originated from the submucosa [Hisa et al 2008]. This case indicated that duodenal papillitis might be one of the other organ involvement in patient of AIP.…”

Section: Pathogenesismentioning

confidence: 99%

The therapeutic strategy for autoimmune pancreatitis is subject to the endoscopic features of the duodenal papilla

Kubota

Nakajima

2010

Therap Adv Gastroenterol

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Autoimmune pancreatitis (AIP) often presents with a swollen duodenal papilla, however, the clinical significance of the duodenal papilla in AIP has not been fully elucidated. Data have shown swollen duodenal papillae shaped like a pear and/or with a submucosal tumor having IgG4-bearing plasma cells. Immunohistopathology has potentially verified duodenal papillitis associated with AIP. FOXP3-positive lymphocytes are also recognized in AIP. AIP has shown spontaneous remission and relapse irrelevance to corticosteroid therapy. The results of a multivariate analysis revealed the absence of a swollen duodenal papilla as the only significant independent factor predictive of spontaneous remission in AIP cases. In addition, the results of another multivariate analysis revealed the presence of a swollen duodenal papilla and the presence of extrapancreatic lesions as the significant independent factors predictive of relapse in these cases. Results suggest that the lack of a swollen duodenal papilla is a predictive factor for spontaneous remission, and thus negates the need to administer corticosteroids in those AIP patients. In contrast, a swollen duodenal papilla and the presence of extrapancreatic lesions are risk factors for relapse, and those AIP patients are candidates for maintenance corticosteroid therapy to reduce relapse. Therefore, the therapeutic strategy such as the indication for corticosteroid administration is subject to the endoscopic features of the duodenal papilla.

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