Clinical Evaluation of International Consensus Diagnostic Criteria for Type 1 Autoimmune Pancreatitis in Comparison With Japanese Diagnostic Criteria 2011

Introduction: Autoimmune pancreatitis (AIP) type 1 is a special form of chronic pancreatitis with a strong lymphocytic infiltration as the pathological hallmark and other organ involvement (OOI). IgG4-related kidney disease (IgG4-RKD) was first reported as an extrapancreatic manifestation of AIP in 2004. The aim of the present study was to determine the frequency and clinical impact of kidney lesions observed in patients with AIP type 1. Methods: We performed a single-centre retrospective study on a prospectively collected cohort of patients with a histologically proven or highly probable diagnosis of AIP according to the International Consensus Diagnostic Criteria (ICDC) classification. Results: Seventy-one patients with AIP were evaluated. AIP type 1 was diagnosed in 62 (87%) patients. Kidney involvement was present in 17 (27.4%) patients with AIP type 1: 15 (88.2%) males and 2 (11.8%) females. Laboratory and/or imaging signs of kidney involvement were presented at the time of AIP diagnosis in eight (47.1%) patients. In other patients, the onset of kidney involvement occurred between four months and eight years following diagnosis. At the time of the diagnosis of kidney involvement, eight (47.1%) patients showed elevated creatinine, and nine (52.9%) patients showed normal serum creatinine. None of the patients were treated with dialysis. Conclusions: IgG4-RKD was present in 27.4% of patients with AIP type 1, with male gender predominance. In cases of early diagnosis and cortisone treatment, the clinical course was mild in most cases. Regular laboratory control of renal function should be a part of the follow-up of patients with AIP type 1.

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Controversial Issues of Recent Diagnostic Criteria of Type 1 Autoimmune Pancreatitis

The Korean Journal of Pancreas and Biliary Tract ◽

10.15279/kpba.2014.19.1.1 ◽

2014 ◽

Vol 19 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ji Kon Ryu

Keyword(s):

Diagnostic Criteria ◽

Autoimmune Pancreatitis ◽

Controversial Issues ◽

Type 1 Autoimmune Pancreatitis

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Utility of endoscopic ultrasound-guided fine-needle biopsy in the diagnosis of type 1 autoimmune pancreatitis

Endoscopy International Open ◽

10.1055/a-1236-3266 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1855-E1861

Author(s):

Kofi W. Oppong ◽

Pardeep Maheshwari ◽

Manu K. Nayar ◽

Antony Darne ◽

Daniel Parkinson ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Autoimmune Pancreatitis ◽

Needle Biopsy ◽

Final Diagnosis ◽

Fine Needle Biopsy ◽

Pathological Feature ◽

International Consensus ◽

Fine Needle ◽

Type 1 Autoimmune Pancreatitis

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) performs poorly in the histological diagnosis of type 1 autoimmune pancreatitis (AIP). The aim of this study was to assess the performance of fine-needle biopsy (FNB) comparing reverse bevel (RB) and fork-tip (FT) needles. Patients and methods A retrospective study of prospectively maintained databases was performed. Patients with a final diagnosis of type 1 AIP who underwent EUS-FNB during diagnostic workup were included. Pathology reports were reviewed and classified as per international consensus diagnostic criteria (ICDC). The Primary outcome was EUS-FNB sensitivity in diagnosing type 1 AIP. Results Between March 2011 and December 2018, 24 patients with a final diagnosis of type 1 AIP underwent FNB. Six patients underwent biopsy with the RB needle and 18 with the FT needle. Mean age (± SD) 62.2 (± 11.4), 17 (70.8 %) male. No RB samples were diagnostic compared to 14 (78 %) FT; P = 0.001; of which 13 (72 %) were level 1. In eight (44 %) of FT cases a diagnosis was not possible without histology. Initial biopsy was diagnostic in five (62.5 %) of these cases. Including repeat biopsy, seven (87 %) had a diagnosis made by FT needle. Obliterative phlebitis (44 %) was the least frequently identified pathological feature and immunoglobulin (IgG)4 + plasma cells > 10 per high power field (78 %) the most common. Conclusion The FT needle demonstrated good performance for diagnosing type 1 AIP. The results support the preferential use of this core biopsy needle for EUS pancreatic tissue sampling.

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Autoimmune Pancreatitis (AIP) Type 1 and Type 2: An International Consensus Study on Histopathologic Diagnostic Criteria

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/j.ypat.2011.10.010 ◽

2012 ◽

Vol 2012 ◽

pp. 61-62

Author(s):

M.L. Smith

Keyword(s):

Diagnostic Criteria ◽

Autoimmune Pancreatitis ◽

International Consensus

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Regulatory T Cells in Type 1 Autoimmune Pancreatitis

International Journal of Rheumatology ◽

10.1155/2012/795026 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Kazushige Uchida ◽

Takeo Kusuda ◽

Masanori Koyabu ◽

Hideaki Miyoshi ◽

Norimasa Fukata ◽

...

Keyword(s):

T Cells ◽

Regulatory T Cells ◽

Autoimmune Pancreatitis ◽

Plasma Cells ◽

Costimulatory Molecule ◽

International Consensus ◽

Serum Igg4 ◽

Storiform Fibrosis ◽

Type 1 Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP) is a newly recognized pancreatic disorder. Recently, International Consensus Diagnostic Criteria for AIP (ICDC) was published. In this ICDC, AIP was classified into Type 1 and Type 2. Patients with Type 1 AIP have several immunologic and histologic abnormalities specific to the disease, including increased levels of serum IgG4 and storiform fibrosis with infiltration of lymphocytes and IgG4-positive plasmacytes in the involved organs. Among the involved organs showing extrapancreatic lesions, the bile duct is the most common, exhibiting sclerosing cholangitis (IgG4-SC). However, the role of IgG4 is unclear. Recently, it has been reported that regulatory T cells (Tregs) are involved in both the development of various autoimmune diseases and the shift of B cells toward IgG4, producing plasmacytes. Our study showed that Tregs were increased in the pancreas with Type 1 AIP and IgG4-SC compared with control. In the patients with Type 1 AIP and IgG4-SC, the numbers of infiltrated Tregs were significantly positively correlated with IgG4-positive plasma cells. In Type 1 AIP, inducible costimulatory molecule (ICOS)+and IL-10+Tregs significantly increased compared with control groups. Our data suggest that increased quantities of ICOS+Tregs may influence IgG4 production via IL-10 in Type 1 AIP.

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