Clinical and morphological characteristics of type 1 and 2 autoimmune pancreatitis

Rationale: In the recent years, an increased interest to autoimmune pancreatitis (AIP) has been seen, related to growing diagnostic potential. In its turn, this leads to an increase in numbers of diagnosed AIP cases. At present, two types of AIP have been described with diverse clinical manifestation and morphology of the pancreas. However, the reproducibility of the differential diagnosis between AIP type 1 and 2 is low even among pancreatic pathologists.Aim: To identify criteria for the morphologic diagnosis of AIP type 1 and 2.Materials and methods: A morphological study of biopsy and surgical specimens from 26 patients with AIP was performed. There were 22 cases of AIP type 1 and 4 cases of AIP type 2. In addition to hematoxylin eosin staining of the specimens, immunohistochemistry was used with counting of CD138+ absolute numbers, determination of IgG+ and IgG4+ cells in the inflammatory infiltrates, as well as the ratios of IgG4+/IgG+ and IgG4+/CD138+ cells.Results: AIP type 1 was characterized by storiform fibrosis of the pancreatic tissue (81.8% cases), involving the parapancreatic fat tissue, by moderateto-severe lymphoplasmocytic infiltration and signs of obliterative/non-obliterative phlebitis. Type 2 AIP was characterized by severe fibrosis with predominantly periductal (centrilobular) fibrosis and mild chronic inflammatory infiltration of the pancreas, while there was no extension of fibrosis and inflammatory infiltration to the parapancreatic tissues in any case. The mean number of CD138+ cell in AIP type 1 was 101.2 ± 27.9 per 1 high-power field (HPF), and in AIP type 2, it was 42.8 ± 20.9 per 1 HPF. The mean absolute number of IgG+ cells in AIP type 1 was 99.6 ± 25.7 per 1 HPF, whereas in AIP type 2, 42.1 ± 20.8 per 1 HPF. In AIP type 1, the mean number of IgG4+ plasmatic cells in the infiltrates was 74.5 ± 27.2 per 1 HPF, whereas in AIP type 2, it was 3.4 ± 2.7 per 1 HPF. The IgG4+/IgG+ ratio was 75 ± 12.6% vs. 8.4 ± 6.2%, and the IgG4+/CD138+ ratio was 72.4 ± 12.3% vs. 8.3 ± 5.9% in AIP type 1 and type 2, respectively.Conclusion: For the differential diagnosis of type 1 and 2 AIP, it is necessary to take into consideration not only typical histological abnormalities, but also the numbers of CD138+, IgG+ and IgG4+ cells within the inflammatory infiltrate, as well as the IgG4+/IgG+ and IgG4+/CD138+ ratios.

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Faculty Opinions recommendation of Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13383010.14750253 ◽

2011 ◽

Author(s):

Chris Forsmark ◽

Dennis Collins

Keyword(s):

Diagnostic Criteria ◽

Autoimmune Pancreatitis ◽

International Consensus

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Modified approach to the characterization of adrenal nodules using a standard abdominal magnetic resonance imaging protocol

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0102 ◽

2017 ◽

Vol 50 (1) ◽

pp. 19-25 ◽

Cited By ~ 3

Author(s):

António P. Matos ◽

Richard C. Semelka ◽

Vasco Herédia ◽

Mamdoh AlObaidiy ◽

Filipe Veloso Gomes ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Imaging Protocol ◽

Intensity Index ◽

Abdominal Magnetic Resonance Imaging ◽

Phase Type ◽

The Mean ◽

Magnetic Resonance Imaging Protocol ◽

Type 3

Abstract Objective: To describe a modified approach to the evaluation of adrenal nodules using a standard abdominal magnetic resonance imaging protocol. Materials and Methods: Our sample comprised 149 subjects (collectively presenting with 132 adenomas and 40 nonadenomas). The adrenal signal intensity index was calculated. Lesions were grouped by pattern of enhancement (PE), according to the phase during which the wash-in peaked: arterial phase (type 1 PE); portal venous phase (type 2 PE); and interstitial phase (type 3 PE). The relative and absolute wash-out values were calculated. To test for mean differences between adenomas and nonadenomas, Student's t-tests were used. Receiver operating characteristic curve analysis was also performed. Results: The mean adrenal signal intensity index was significantly higher for the adenomas than for the nonadenomas (p < 0.0001). Chemical shift imaging showed a sensitivity and specificity of 94.4% and 100%, respectively, for differentiating adenomas from nonadenomas. Of the adenomas, 47.6%, 48.5%, and 3.9%, respectively, exhibited type 1, 2, and 3 PEs. For the mean wash-in proportions, significant differences were found among the enhancement patterns. The wash-out calculations revealed a trend toward better lesion differentiation for lesions exhibiting a type 1 PE, showing a sensitivity and specificity of 71.4% and 80.0%, respectively, when the absolute values were referenced, as well as for lesions exhibiting a type 2 PE, showing a sensitivity and specificity of 68.0% and 100%, respectively, when the relative values were referenced. The calculated probability of a lipid-poor lesion that exhibited a type 3 PE being a nonadenoma was > 99%. Conclusion: Subgrouping dynamic enhancement patterns yields high diagnostic accuracy in differentiating adenomas from nonadenomas.

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There is a Correlation between Fragility Fractures of the Pelvis and a Circle-Type Morphology of the True Pelvis, but Not with Pelvic Incidence

Gerontology and Geriatric Research ◽

10.31487/j.ggr.2021.01.01 ◽

2021 ◽

pp. 1-6

Author(s):

Matthias Spalteholz ◽

Gulow Jens ◽

Pap Geza

Keyword(s):

Pelvic Incidence ◽

Fragility Fractures ◽

Statistical Correlation ◽

X Ray ◽

Lack Of Information ◽

The Mean ◽

Fracture Types ◽

Type 3

Purpose: Osteoporosis is a major risk factor for the development of fragility fractures of the pelvis (FFP). There is a lack of information about the influence of anatomical conditions such as Pelvic Incidence and Pelvic Ratio (DT/DS ratio) on this kind of fractures. Methods: This is a monocentric retrospective analysis. X-ray images of the lumbar spine and pelvis and 3D-MPR CT reconstructions of the pelvis were analysed to determine Pelvic Incidence (PI) and Pelvic Ratio (PR) in 141 fragility fractures of the pelvis. Statistical analyses were performed to examine the correlation between these spinopelvic parameters and fragility fractures of the pelvis. Results: A total of 141 fragility fractures of the pelvis (14 men = 9.93%, 127 women = 90.07%) were analysed. According to the FFP-classification we recognized FFP type 1 fractures in 19.15%, FFP type 2 in 41.13%, FFP type 3 in 8.51% and FFP type 4 fractures in 32.21%. The mean PI was 58.83º. There was no statistical correlation between PI and fracture types (p=0.81). The mean PR was 1.099. 57 patients (40.43%) demonstrated a DT/DS ratio ≤ 1.06, corresponding to a circle-type morphology. 24 patients (17.02%) demonstrated a DT/DS ratio ≥ 1.18, corresponding to an ellipse-type pelvis. A circle-type pelvis is significantly more often associated with fragility fractures of the pelvis than an ellipse-type morphology (p<0.001). Conclusion: The results of our work demonstrate a strong statistical correlation between the circle-type morphology of the pelvis (PR ≤ 1.06) and fragility fractures of the pelvis. There is no statistical correlation between fragility fractures of the pelvis and Pelvic Incidence.

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Recent advances in autoimmune pancreatitis: type 1 and type 2

Gut ◽

10.1136/gutjnl-2012-304224 ◽

2013 ◽

Vol 62 (9) ◽

pp. 1373-1380 ◽

Cited By ~ 114

Author(s):

Terumi Kamisawa ◽

Suresh T Chari ◽

Markus M Lerch ◽

Myung-Hwan Kim ◽

Thomas M Gress ◽

...

Keyword(s):

Autoimmune Pancreatitis ◽

Recent Advances

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Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

Acta Radiologica ◽

10.1080/02841850701342138 ◽

2007 ◽

Vol 48 (6) ◽

pp. 628-634 ◽

Cited By ~ 25

Author(s):

M. Loy ◽

E. Perra ◽

A. Melis ◽

M. E. Cianchetti ◽

M. Piga ◽

...

Keyword(s):

Blood Flow ◽

Differential Diagnosis ◽

Clinical Outcome ◽

Doppler Sonography ◽

Color Flow ◽

Therapeutic Choice ◽

Color Flow Doppler Sonography ◽

Increased Blood Flow

Background: Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice. Purpose: To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT. Material and Methods: The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone. Results: Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive. Conclusion: CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.

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Autoimmune Pancreatitis

10.2310/gastro.5467 ◽

2018 ◽

Author(s):

Allison L Yang ◽

Julia McNabb-Baltar

Keyword(s):

Chronic Pancreatitis ◽

Obstructive Jaundice ◽

Autoimmune Pancreatitis ◽

Pancreatic Insufficiency ◽

Imaging Findings ◽

Laboratory Findings ◽

Related Disease

Autoimmune pancreatitis (AIP) is a subcategory of chronic pancreatitis that is highly responsive to steroids. The term was first proposed in 1995 by Yoshida and colleagues, and since its discovery, the diagnosis of AIP has dramatically increased. AIP is a chronic fibroinflammatory disease characterized by lymphoplasmacytic infiltrates and fibrosis on histology. There are two distinct subtypes: type 1 AIP is the pancreatic manifestation of a systemic serum immunoglobulin G subtype 4–related disease (IgG4-RD) and type 2 AIP is described clinically as idiopathic duct-centric pancreatitis and has no association with IgG4. Clinically, AIP presents most commonly as obstructive jaundice in type 1 AIP and can present as acute pancreatitis in type 2 AIP. The diagnostic criteria include histology, imaging findings, and responsiveness to steroids as well as laboratory findings and other organ involvement. The mainstay of treatment is steroid therapy, with immunomodulators such as rituximab used for maintenance or relapsing disease. Long-term complications of AIP include pancreatic insufficiency and are often associated with relapsing disease. This review contains 45 references, 1 figure, and 2 tables. Key Words: autoimmune pancreatitis, chronic pancreatitis, EUS-guided biopsy, IgG4, immunomodulatory, obstructive jaundice, pancreas mass, steroid

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Surgery in autoimmune pancreatitis

Digestive Surgery ◽

10.1159/000521490 ◽

2021 ◽

Author(s):

Sara Nikolic ◽

Poya Ghorbani ◽

Raffaella Pozzi Mucelli ◽

Sam Ghazi ◽

Francisco Baldaque- Silva ◽

...

Keyword(s):

Autoimmune Pancreatitis ◽

University Hospital ◽

Premalignant Lesions ◽

Single Centre ◽

Age At Surgery ◽

Diagnostic Work ◽

Work Up

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

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Glycera sheikhmujibi n. sp. (Annelida: Polychaeta: Glyceridae): A New Species of Glyceridae from the Saltmarsh of Bangladesh

Diversity ◽

10.3390/d12060213 ◽

2020 ◽

Vol 12 (6) ◽

pp. 213

Author(s):

M. Hossain ◽

Pat Hutchings

Keyword(s):

Electron Microscope ◽

New Species ◽

Scanning Electron Microscope ◽

Morphological Characteristics ◽

Longitudinal Ridge ◽

Type 3 ◽

A New Species ◽

Scanning Electron

A new species of glycerid polychaete, Glycera sheikhmujibi, is described from the saltmarsh on the central coast of Bangladesh. The species is identified based on morphological characteristics using both a light microscope and scanning electron microscope (SEM). The species is characterized by the presence of three distinct types of proboscideal papillae: type 1 papillae (conical with three transverse ridges), type 2 (conical with a straight, median, longitudinal ridge), and type 3 (round, shorter, and broader, with a straight, median, longitudinal ridge). It has a Y-shaped aileron with gently incised triangular base, almost equal-size digitiform noto- and neuropodial lobes in the mid-body, and long ventral cirri at the posterior end. The new species is compared with its related species, previously described from the Bay of Bengal region. A key to all these species is provided.

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Expression of cyclooxygenase-2 in orbital fibroadipose connective tissues of Graves’ ophthalmopathy patients

Acta Endocrinologica ◽

10.1530/eje.1.02280 ◽

2006 ◽

Vol 155 (5) ◽

pp. 681-685 ◽

Cited By ~ 13

Author(s):

E Berrin Yuksel Konuk ◽

Onur Konuk ◽

Muge Misirlioglu ◽

Adnan Menevse ◽

Mehmet Unal

Keyword(s):

Disease Duration ◽

Clinical Activity ◽

Connective Tissues ◽

Positive Correlation ◽

Graves Ophthalmopathy ◽

Compressive Neuropathy ◽

The Mean ◽

Cox 2

Objective: The aim of this study is to evaluate the expression of cycloocygenase-2 (COX-2) in orbital fibroadipose connective tissue in Graves’ ophthalmopathy (GO) patients, and investigate the associations between COX-2 expression and GO characteristics. Methods: The orbital fibroadipose connective tissues of 23 cases demonstrating moderate or severe GO, and eight control subjects without any history of thyroid or autoimmune disease were analyzed for COX-2 mRNA expression. Real-time relative quantitative PCR was performed to assess transcripts of COX-2 using the LightCycler. The disease activity was evaluated by the clinical activity score (CAS). The clinical features of GO were evaluated by total eye score (TES) and the cases were divided into two groups; type 1 cases included higher degrees of proptosis with orbital fat volume increase, and type 2 cases included cases with compressive neuropathy and limited extraocular muscle functions. Results: The mean ± s.d. disease duration was 5.7 ± 7.1 years. The mean ± s.d. CAS and TES of cases were 1.60 ± 1.04 and 7.5 ± 1.8 respectively. The mean ± s.d. expression of COX-2 was 0.023 ± 0.013 and 0.010 ± 0.002 in GO cases and controls (P = 0.008), and 0.015 ± 0.073 and 0.029 ± 0.135 in type 1 and type 2 cases respectively (P = 0.007). COX-2 expression showed a statistically significant positive correlation with TES (r = 0.634, P = 0.001), and a negative correlation with the disease duration (r = −0.621, P = 0.002). Conclusions: COX-2 is expressed at higher levels in orbital fibroadipose tissues of GO cases. This showed a positive correlation with increasing severity of orbital disease suggesting possible relation with COX-2 expression and orbital inflammation in GO.

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