Autoimmune pancreatitis: pathologic subtypes and their implications for its diagnosis.

Published on Sep 1, 2009in The American Journal of Gastroenterology10.171
· DOI :10.1038/AJG.2009.336
Aravind Sugumar17
Estimated H-index: 17
(Mayo Clinic),
Günter Klöppel35
Estimated H-index: 35
(TUM: Technische Universität München),
Suresh T. Chari83
Estimated H-index: 83
Sources
Abstract
Autoimmune pancreatitis (AIP) is a rare but treatable form of pancreatic disease that is being increasingly recognized worldwide. The diagnosis of AIP remains a clinical challenge and the difficulty is compounded by the fact that there are no internationally agreed on diagnostic criteria for AIP. One of the reasons for the lack of consensus on diagnostic criteria could be that the term "AIP" likely refers to more than one distinct disease or subtype. This may explain the divide between European and other diagnostic criteria. Recent insights into AIP subtypes should help develop an evidence-based consensus on diagnostic criteria for the disease.
📖 Papers frequently viewed together
2,772 Citations
762 Citations
998 Citations
References17
Newest
#1Phil A. Hart (The Ohio State University Wexner Medical Center)H-Index: 25
#2Yoh Zen (Kobe University)H-Index: 69
Last. Suresh T. Chari (Mayo Clinic)H-Index: 83
view all 3 authors...
Autoimmune pancreatitis (AIP) is distinct from calcifying and obstructive forms of chronic pancreatitis. Clinically and histologically it has two distinct subsets: (i) lymphoplasmacytic sclerosing pancreatitis or type 1 AIP which appears to be a systemic disease characterised by abundant infiltration of affected organs with immunoglobulin G4 (IgG4)-positive plasma cells and (2) duct-centric or type 2 AIP characterised by granulocyte epithelial lesions in the pancreas without systemic involvement...
411 CitationsSource
#1Luca Frulloni (University of Verona)H-Index: 44
#2Chiara Scattolini (University of Verona)H-Index: 7
Last. Italo Vantini (University of Verona)H-Index: 32
view all 12 authors...
OBJECTIVES: Autoimmune pancreatitis (AIP) is a particular type of chronic pancreatitis that can be classified into diffuse and focal forms. The aim of this study was to analyze clinical and instrumental features of patients suffering from the diffuse and focal forms of AIP. METHODS: AIP patients diagnosed between 1995-2008 were studied. RESULTS: A total of 87 AIP patients (54 male and 33 female patients, mean age 43.4±15.3 years) were studied. Focal-type AIP was diagnosed in 63% and diffuse-type...
264 CitationsSource
#1Amit Raina (University of Pittsburgh)H-Index: 8
#2Dhiraj YadavH-Index: 42
Last. Adam SlivkaH-Index: 51
view all 8 authors...
OBJECTIVES : Autoimmune pancreatitis (AIP) is increasingly recognized as a form of chronic pancreatitis. Systematic evaluation and management of AIP in the United States is reported only from one center. Our aim was to review the evaluation and management of AIP at a large tertiary center. METHODS: We retrospectively reviewed information on demographics, clinical presentation, laboratory and imaging findings, extrapancreatic involvement, treatment response, and recurrence in 26 patients with AIP...
269 CitationsSource
#1Sönke Detlefsen (Aalborg Hospital)H-Index: 20
#2Asbjørn Mohr Drewes (Aalborg Hospital)H-Index: 59
Last. Günter KlöppelH-Index: 87
view all 4 authors...
Autoimmune pancreatitis (AIP) has been established as a special entity of chronic pancreatitis (CP). However, its clinical distinction from pancreatic cancer and other types of CP is still difficult. The aim of this study was to evaluate the efficacy of pancreatic core needle biopsy for the diagnosis of AIP. In 44 core needle biopsy specimens, we assessed the following microscopic features: granulocytic epithelial lesions (GELs), more than ten IgG4-positive plasma cells/HPF, more than ten eosino...
131 CitationsSource
#1Aravind SugumarH-Index: 17
#2Thomas C. SmyrkH-Index: 98
Last. Suresh T. ChariH-Index: 83
view all 5 authors...
9 CitationsSource
#1Makoto Otsuki (University of Occupational and Environmental Health Japan)H-Index: 33
#2Jae Bock ChungH-Index: 31
Last. Yasuyuki Kihara (University of Occupational and Environmental Health Japan)H-Index: 18
view all 15 authors...
In 2002, the Japan Pancreas Society (JPS) was the first in the world to propose diagnostic criteria for autoimmune pancreatitis (AIP). Since the concept of AIP has changed with the accumulation of AIP cases, the Research Committee of Intractable Pancreatic Diseases (RCIPD) provided by the Ministry of Health, Labour and Welfare of Japan and the JPS issued revised clinical diagnostic criteria of AIP in 2006. The Asan Medical Center of Korea also proposed diagnostic criteria for AIP in 2006. Howeve...
564 CitationsSource
#1Suresh T. Chari (Mayo Clinic)H-Index: 83
#2Joseph A. Murray (Mayo Clinic)H-Index: 77
75 CitationsSource
Autoimmune pancreatitis (AIP) is a recently defined form of chronic pancreatitis. While numerous case reports and small case series of AIP have been reported from Japan, there have been relatively few from the West. Based on a retrospective review of our experience with resected AIP and a review of the literature, we have identified five cardinal features of AIP in histology, imaging, serology, other organ involvement, and response to steroid therapy, which are summarized in the mnemonic HISORt....
287 CitationsSource
#1Motohiro Kojima (CAU: University of Kiel)H-Index: 7
#1Motohiro Kojima (CAU: University of Kiel)H-Index: 1
Last. Günter KlöppelH-Index: 87
view all 9 authors...
Autoimmune pancreatitis (AIP) is a newly recognized disease. The presence of IgG4 positive plasma cells is thought to be of diagnostic help. In a surgical series of chronic pancreatitis cases, we determined the relative frequency of AIP before and after 1990, analyzed the diagnostic significance of IgG4 expression and examined the presence of oligoclonal T or B-cell populations. The histopathology of 202 surgical specimens of chronic pancreatitis removed between 1975 and 2004 was reviewed and 2 ...
175 CitationsSource
#1Suresh T. Chari (Mayo Clinic)H-Index: 83
#2Thomas C. Smyrk (Mayo Clinic)H-Index: 98
Last. Michael B. Farnell (Mayo Clinic)H-Index: 71
view all 11 authors...
Background & Aims: The Japan Pancreas Society criteria for diagnosis of autoimmune pancreatitis (AIP) mandate presence of characteristic imaging (diffuse pancreatic enlargement with diffusely irregular, narrow pancreatic duct). AIP has unique histologic features associated with infiltration of tissues of affected organs with abundant IgG4-positive cells. We propose expanded diagnostic criteria for AIP with a cohort of histologically confirmed AIP. Methods: We reviewed the pancreatic imaging find...
1,118 CitationsSource
Cited By132
Newest
#1Mario Pelaez-Luna (UNAM: National Autonomous University of Mexico)H-Index: 17
Last. L.F. Uscanga-DomínguezH-Index: 5
view all 4 authors...
Source
#1Luca Barresi (ISMETT)H-Index: 21
#2Matteo Tacelli (ISMETT)H-Index: 5
Last. EndoscopistsH-Index: 1
view all 29 authors...
BackgroundAutoimmune pancreatitis (AIP) is a rare, and relatively new, form of chronic pancreatitis. The management of AIP can vary considerably among different centres in daily clinical practice.O...
3 CitationsSource
#1Akira Satou (Aichi Medical University)H-Index: 8
#2Kenji NotoharaH-Index: 37
Last. Yasuharu Sato (RMIT: RMIT University)H-Index: 31
view all 7 authors...
IgG4-related disease (RD) is a relatively new entity, which was first proposed in 2001. Since then, clinical and pathological characteristics of the disease have been investigated. As IgG4-RD has been studied extensively, the diagnostic criteria for IgG4-RD of each organ and the comprehensive diagnostic criteria for IgG4-RD have also been developed. However, one of the biggest challenges in the field is distinguishing between IgG4-RD and mimickers, which show overlapping features with IgG4-RD. I...
2 CitationsSource
Source
Source
#1Ralph H. Hruban (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 173
#2David S. Klimstra (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 120
Last. Günter Klöppel (TUM: Technische Universität München)H-Index: 35
view all 4 authors...
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, ...
Source
#1Rui MarinhoH-Index: 3
#2António AlvesH-Index: 2
Last. Vitor NunesH-Index: 4
view all 4 authors...
: A 24-year-old black male presented with a 1-week obstructive jaundice and intermittent abdominal pain, with no significant weight loss and an unsuspicious abdominal exam. Blood chemistry showed a cholestatic pattern but a complete immunological and tumoral panel (anti-smooth muscle antibody, anti-mitochondrial antibody, anti-nuclear antibody, anti-neutrophil cytoplasmic antibody, anti-Smith, anti-double-stranded-DNA antibody (anti-dsDNA), complement C3/C4, carcinoembryonic antigen, CA 19-9 and...
1 CitationsSource
#1Henry Y. Jiang (Northern Ontario School of Medicine)H-Index: 3
#2Erica L. Kohtakangas (Northern Ontario School of Medicine)H-Index: 3
Last. Jeffrey B. Shum (Northern Ontario School of Medicine)H-Index: 1
view all 5 authors...
1 CitationsSource
: Autoimmune pancreatitis (AIP) is steroid-responsive fibroinflammatory disorder of the pancreas. There are 2 distinct subtypes of AIP, types 1 and 2. Type 1 is associated with systemic immunoglobulin (Ig)G4 disease and may affect multiple organs in the body. Type 2 is confined to the pancreas and shows an association with ulcerative colitis. This article describes the imaging findings of AIP and IgG4 disease in the liver, bile ducts, kidneys, and the retroperitoneal regions. The imaging differe...
6 CitationsSource
#1Gitta Maria Seleznik (UZH: University of Zurich)H-Index: 9
#2Theresia Reding (UZH: University of Zurich)H-Index: 10
Last. Rolf Graf (UZH: University of Zurich)H-Index: 56
view all 12 authors...
Objective Chronic pancreatitis (CP) and autoimmune pancreatitis (AIP) are characterised by different inflammatory processes. If pancreatic inflammation is a prerequisite for autoimmunity is still unclear. AIP is considered mostly a T cell-mediated disease; however, in induction of CP, macrophages play a pivotal role. p21—a member of cyclin-dependent kinase inhibitors—can influence inflammatory processes, in particular can regulate T cell activation and promote macrophage development. We therefor...
7 CitationsSource