scholarly journals [Eosinophilic pancreatitis and autoimmune pancreatitis: comparison, differential diagnosis, and treatment]

2017 ◽  
Vol 11 (1) ◽  
Author(s):  
Mauro Turrin ◽  
Sergio Martinelli
Keyword(s):  
Acute Pancreatitis ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Diagnostic Criteria ◽  
Autoimmune Pancreatitis ◽  
Pancreatic Neoplasms ◽  
Low Frequency ◽  
Systemic Diseases ◽  
Histological Confirmation

Among the rarest causes of acute pancreatitis, there are eosinophilic pancreatitis (EP) and autoimmune pancreatitis (AIP). They share some features, such as the low frequency and the association with systemic disorders. Their diagnostic criteria, mainly clinical and laboratory, are different, but both require histological confirmation in most cases: in fact, pancreas is enlarged at CT scan, with tumor-like appearance.Here we discuss the importance of hypereosinophilia in EP and IgG increase in type 1 AIP (included in IgG-related systemic diseases). Differential diagnosis with pancreatic neoplasms and therapy schedules are discussed as well.

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

Pancreas ◽  
2013 ◽  
Vol 42 (8) ◽  
pp. 1238-1244 ◽  
Author(s):  
Itaru Naitoh ◽  
Takahiro Nakazawa ◽  
Kazuki Hayashi ◽  
Katsuyuki Miyabe ◽  
Shuya Shimizu ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Evaluation ◽  
Autoimmune Pancreatitis ◽  
International Consensus ◽  
Type 1 Autoimmune Pancreatitis

scholarly journals Clinical and morphological characteristics of type 1 and 2 autoimmune pancreatitis

2018 ◽  
Vol 46 (4) ◽  
pp. 330-337
Author(s):  
S. V. Lishchuk ◽  
Е. A. Dubova ◽  
K. А. Pavlov ◽  
Yu. D. Udalov
Keyword(s):  
Differential Diagnosis ◽  
Autoimmune Pancreatitis ◽  
Morphological Characteristics ◽  
High Power Field ◽  
Obliterative Phlebitis ◽  
Inflammatory Infiltration ◽  
Diagnostic Potential ◽  
The Mean

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.

scholarly journals Autoimmune Pancreatitis Type 2: Case Report

2017 ◽  
Vol 5 (4) ◽  
pp. 232470961773424 ◽  
Author(s):  
Chidinma Onweni ◽  
Harika Balagoni ◽  
Jennifer M. Treece ◽  
Emmanuel Addo Yobo ◽  
Archi Patel ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Acute Pancreatitis ◽  
Case Report ◽  
Autoimmune Pancreatitis ◽  
Corticosteroid Treatment ◽  
Unknown Etiology ◽  
Inflammatory Bowel ◽  
Igg4 Antibody

A middle-aged man presents with acute pancreatitis of unknown etiology and is found to have a presentation consistent with the diagnosis of type 2 autoimmune pancreatitis (AIP). AIP is a group of rare heterogeneous diseases that are challenging to diagnose. There are 2 types of AIP. Type 1 disease is the more common worldwide than type 2 AIP. While type 1 AIP is associated with IgG4-positive antibodies, type 2 AIP is IgG4 antibody negative. Both types of AIP are responsive to corticosteroid treatment. Although type 1 AIP has more extrapancreatic manifestations and more commonly relapses, this is a case of a patient with type 2 AIP with inflammatory bowel disease and relapsing course.

scholarly journals A Rare Multifocal Pattern of Type 2 Autoimmune Pancreatitis with Negative IgG4: A Potential Diagnostic Pitfall That May Mimic Multifocal Pancreatic Adenocarcinoma

2018 ◽  
Vol 12 (1) ◽  
pp. 46-55 ◽  
Author(s):  
Partha Hota ◽  
Tejas Patel ◽  
Xiaofeng Zhao ◽  
Nirag Jhala ◽  
Omar Agosto
Keyword(s):  
Acute Pancreatitis ◽  
Mr Imaging ◽  
Pancreatic Adenocarcinoma ◽  
Autoimmune Pancreatitis ◽  
Diagnostic Pitfall ◽  
First Case ◽  
Imaging Characteristics ◽  
Sclerosing Pancreatitis

Autoimmune pancreatitis (AIP) is an increasingly recognized form of acute pancreatitis characterized by obstructive jaundice with a rapid and dramatic treatment response to steroid therapy. Recently, AIP has been divided into two distinct phenotypes: lymphoplasmocytic sclerosing pancreatitis AIP (type 1) and idiopathic duct-centric pancreatitis AIP (type 2); each of which have their own distinct demographics, diagnostic criteria, and histopathological features. We report, to the best of our knowledge, the first case of a multifocal pattern of type 2 AIP characterized with both CT and MR imaging. This rare imaging pattern of AIP may mimic the appearance of more worrisome malignant etiologies such as multifocal pancreatic adenocarcinoma or lymphoma, with overlapping imaging characteristics potentially complicating or delaying diagnosis. Therefore, recognition of this atypical pattern of AIP and avoidance of this potential diagnostic pitfall is crucial.

scholarly journals Autoimmune Pancreatitis Type 1 Associated with a Pancreatic Pseudocyst

2019 ◽  
Vol 13 (1) ◽  
pp. 195-199
Author(s):  
Felix Hesse ◽  
Rickmer Braren ◽  
Roland M. Schmid ◽  
Veit Phillip
Keyword(s):  
Differential Diagnosis ◽  
Autoimmune Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Elevated Serum ◽  
Response To Treatment ◽  
Cystic Lesions ◽  
Serum Igg4 ◽  
Underlying Pathology ◽  
Tomography Scan

Pancreatic cystic lesions comprise diverse entities with different histopathological characteristics. Differential diagnosis is often challenging. Autoimmune pancreatitis (AIP) is usually not considered an underlying pathology in the differential diagnosis of peri-/pancreatic pseudo-/cystic lesions. We report the case of a 73-year-old male with diffuse pancreatic enlargement and an adjacent cystic lesion (60 × 80 mm) on computed tomography scan. Based on these imaging findings and an elevated serum IgG4 concentration, AIP complicated by a pancreatic pseudocyst was diagnosed, and treatment with glucocorticoids was started. Regular follow-ups showed a good response to treatment with regression of the pancreatic pseudocyst and remittent pancreatic swelling.

scholarly journals The Role of EUS-Guided FNA and FNB in Autoimmune Pancreatitis

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1653
Author(s):  
Nicolò de Pretis ◽  
Stefano Francesco Crinò ◽  
Luca Frulloni
Keyword(s):  
Pancreatic Cancer ◽  
Autoimmune Pancreatitis ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Tissue Architecture ◽  
Fine Needle ◽  
Tissue Acquisition ◽  
Histological Confirmation

Autoimmune pancreatitis (AIP) is an increasingly recognized disease classified into two different subtypes based on histology. According to the International Diagnostic Criteria (ICDC), the diagnosis is achieved using a combination of different criteria. In patients presenting with a typical imaging appearance, the diagnosis may be straightforward, and steroid treatment is recommended, even without histological confirmation. In patients with atypical imaging or mass-forming appearance, the differential diagnosis with pancreatic cancer is challenging and crucial for treatment strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition has been proposed to achieve a histological diagnosis. Fine-needle aspiration (FNA) was first proposed to aspirate cells from pancreatic lesions. Despite excellent results in terms of sensitivity for pancreatic cancer, the data are disappointing regarding the diagnosis of AIP. The recent development of new needles allowing fine-needle biopsy (FNB) has been associated with improved diagnostic accuracy based on preserving the tissue architecture, which is necessary to detect the typical histological features of AIP. However, the published literature on the role of EUS-guided FNA and FNB is limited and mainly focused on type 1 AIP. The present study aimed to review the available literature on the role of EUS-guided FNA and FNB in the diagnosis of AIP.

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