Retrospective Comparison Between Preoperative Diagnosis by International Consensus Diagnostic Criteria And Histological Diagnosis in Patients With Focal Autoimmune Pancreatitis Who Underwent Surgery With Suspicion of Cancer
The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery.Thirty patients (type 1 AIP in 23 and type 2 AIP in 7) with a diagnosis of AIP based on histology of surgical specimens were classified according to ICDC based on their preoperative data.Pancreatic core biopsies and diagnostic steroid trial were not preoperatively performed in any of the patients. Based on preoperative data, ICDC diagnosed 6 patients (20%) as having type 1 AIP and 24 (80%) as probable AIP. Assuming all patients had responded to a steroid trial preoperatively, ICDC would have diagnosed 8 patients (27%) as having type 1 AIP, 4 (13%) as type 2 AIP, 10 as AIP-not otherwise specified (33%), and 8 (27%) as probable AIP. In the hypothetical situation, 7 of 8 type 1 AIP patients and 3 of 3 type 2 AIP patients would have been classified into the correct subtype of AIP.A steroidtrial enhances the possibility of correctly diagnosing AIP by ICDC despite the lack of histology. However, some patients cannot be diagnosed as having AIP or be classified into the correct subtype without histology.
Background High serum immunoglobulin G4 (IgG4) levels and infiltration of IgG4-positive cells are characteristic of Type 1 autoimmune pancreatitis (AIP). We previously reported that increased regulatory T cells (Tregs) may regulate IgG4 production in AIP. Although an increased serum IgG4 concentration is observed in some patients with pancreatic ductal adenocarcinoma (PDA), clarification is still necessary. We have therefore studied the correlations between IgG4-positive cells and Tregs in patie...
It is now clear that are two histological types (Type 1 and Type 2) of autoimmune pancreatitis (AIP). The histological pattern of Type-1 AIP, or traditional AIP, is called lymphoplasmacytic sclerosing pancreatitis. The histological pattern of Type-2 AIP is characterized by neutrophilic infiltration in the epithelium of the pancreatic duct. In general, Type-2 AIP patients are younger, may not have a male preponderance, and rarely show elevation of serum IgG4 compared with Type-1 AIP patients. Unl...
Background It is controversial whether EUS-guided FNA by using 22-gauge (G) needles is useful for the diagnosis or evaluation of autoimmune pancreatitis (AIP). Objective To evaluate the usefulness of EUS-FNA by 22-G needles for the histopathological diagnosis of AIP. Design A retrospective study. Setting Single academic center. Patients A total of 273 patients, including 25 with AIP, underwent EUS-FNA and histological examinations. Results EUS-FNA by using 22-G needles provided adequate tissue s...
Last. Günter Klöppel(TUM: Technische Universität München)H-Index: 38
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Abstract Background At the recent consensus conference on autoimmune pancreatitis (AIP) in Honolulu, we presented preliminary data from our study of surgically treated AIP patients. Our data strongly supported the separation of AIP into type 1 and type 2. Our study is based on a total of 114 surgically treated European AIP patients. Our aims were to elucidate serum IgG4 elevation, other organ involvement, relapse of disease, steroid treatment and diabetes after surgery in 114 surgically treated ...
Last. Eunsil Yu(UOU: University of Ulsan)H-Index: 32
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Background and Aim: Type 2 autoimmune pancreatitis (AIP) has been reported mainly in Western countries and is thought to be very rare in Asia. The aim of this study was to compare the prevalence, clinical profiles, detailed radiological findings, and steroid responsiveness between type 1 and type 2 AIP in Korea. Methods: From 120 patients diagnosed with AIP between January 2003 and August 2010, 52 patients with histologically confirmed type 1 (n = 37) or type 2 (n = 15) AIP were included. Result...
The authors review imaging findings of autoimmune pancreatitis, with emphasis on the extrapancreatic manifestations of IgG4-related sclerosing disease in the bile ducts, gallbladder, kidneys, retroperitoneum, thyroid, salivary glands, lung, mediastinum, lymph nodes, and prostate.
Background/Aims: Recent data demonstrate the presence of two autoimmune pancreatitis (AIP) subtypes. All existing endoscopic ultrasonography-guided trucut biopsy (EUS-TCB) data pert
Autoimmune pancreatitis is a disease characterized by specific pathological features, different from those of other forms of pancreatitis, that responds dramatically to steroid therapy. The pancreatic parenchyma may be diffusely or focally involved with the possibility of a low-density mass being present at imaging, mimicking pancreatic cancer. Clinically, the most relevant problems lie in the diagnosis of autoimmune pancreatitis and in distinguishing autoimmune pancreatitis from pancreatic canc...
Objectives:To achieve the goal of developing international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis (AIP).Methods:An international panel of experts met during the 14th Congress of the International Association of Pancreatology held in Fukuoka, Japan, from July 11 through 13,
Last. Makoto Takaoka(Kansai Medical University)H-Index: 24
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Recent studies have suggested the existence of two subtypes of autoimmune pancreatitis (AIP): type 1 AIP, related to IgG4 (lymphoplasmacytic sclerosing pancreatitis); and type 2 AIP, related to a granulocytic epithelial lesion (idiopathic duct-centric chronic pancreatitis). Compared with type 2 AIP, the clinicopathological features of type 1 AIP, with increased serum IgG4/IgE levels, abundant infiltration of IgG4 + plasmacytes and lymphocytes, autoantibodies, and steroid responsiveness, are more...
#1Ralph H. Hruban(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 208
#2David S. Klimstra(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 145
Last. Günter Klöppel(TUM: Technische Universität München)H-Index: 38
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Summary The last fifty years have witnessed an explosion in our understanding of the pathology of pancreatic diseases. Entities known to exist 50 years ago have been defined more precisely and are now better classified. New entities, previously not recognized, have been discovered and can now be treated. Importantly, new tools have been developed that have unraveled the fundamental biological drivers of a number of pancreatic diseases. Many of these same tools have also been applied clinically, ...
Acute pancreatitis is an acute inflammatory process of the pancreatic gland that can involve pancreatic parenchyma or distant organs. The incorporation of the revised Atlanta classification system into everyday practice would provide the use of a standardized terminology and the chance to correctly classify and recognize every imaging finding of acute pancreatitis. It refers to diagnostic criteria, clinical classification—both phases (early and late) and severity (mild, moderately severe, and se...
OBJECTIVES: This study aimed to evaluate magnetic resonance imaging findings of autoimmune pancreatitis (AIP) and to find radiological patterns that could differentiate type 1 and type 2 AIP. METHODS: Eighty-four patients with diagnosis of AIP were enrolled. Image analysis included pancreatic signal intensity abnormalities, enhancement pattern, extrapancreatic involvement, and main pancreatic duct alterations. RESULTS: Pancreatic parenchyma resulted in hypointensity on T1-weighted images in 65 (...
Autoimmune pancreatitis (AIP) is a fibro-inflammatory disease of the pancreas with a postulated immune-mediated mechanism (1,2). Two different histologic subtypes have been described, type 1 and type 2 AIP (3). Type 1 AIP is a more aggressive disease in terms of recurrences and extra-pancreatic organ involvement. International consensus diagnostic criteria (ICDC) have been established to classify the disease without definitive histology (4). ICDC introduced not otherwise specified (NOS) AIP as a...
Background Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of ...
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that can involve regional tissues or even remote organs. In 80–85% of cases AP is self-limiting with minimal clinical manifestations (Bradley 1993). In some cases, however, it can cause even a multiorgan failure (MOF) (Bollen et al. 2007). In this last subset of patients the mortality rate reaches 30% (Foster et al. 2016; Whitcomb 2006). The management of AP is complex and requires, in most severe cases, a multidisciplinary...
Resumen La pancreatitis autoinmune (PAI) es una forma distinta de pancreatitis cronica, que se caracteriza por un mecanismo patogenico autoinmune. Su frecuencia es levemente mayor en los pacientes de sexo masculino (60%) y la edad promedio de presentacion oscila entre los 40 y 60 anos, aunque el rango etario es mucho mas amplio (de 14 a 80 anos). Desde el punto de vista histologico, la PAI se presenta con un infiltrado inflamatorio denso, de extension variable, que puede ser focal o comprometer ...
Abstract Objectives Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis that has been reported worldwide for the last two decades. The aim of this study is to analyse the clinical profile of patients from Spain with AIP, as well as treatments, relapses and long-term outcomes. Methods Data from 59 patients with suspected AIP that had been diagnosed in 15 institutions are retrospectively analysed. Subjects are classified according to the International Consensus Diagnostic Criteria (ICD...
#1Sebastian Rasch(TUM: Technische Universität München)H-Index: 12
#2Veit Phillip(TUM: Technische Universität München)H-Index: 16
Last. Hana Algül(TUM: Technische Universität München)H-Index: 36
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Abstract Background Most of the data about epidemiology, clinical presentation and treatment of autoimmune pancreatitis (AIP) is based on case series or small study groups. We therefore analyzed all cases of AIP treated at our clinic retrospectively. Methods We searched our clinical database for the diagnosis pancreatitis between January 2007 and June 2014, selected patients with AIP and entered all relevant information in a database for statistical analysis. Results In total 53 patients with AI...