Autoimmune Pancreatitis with Histologically Proven Lymphoplasmacytic Sclerosing Pancreatitis with Granulocytic Epithelial Lesions

Abstract

Recent histological and clinical studies have suggested the existence of 2 distinct types of autoimmune pancreatitis (AIP): type 1 AIP related to IgG4, exhibiting lymphoplasmacytic sclerosing pancreatitis (LPSP), and type 2 AIP related to granulocyte epithelial lesions (GELs), exhibiting idiopathic duct-centric chronic pancreatitis (IDCP). We herein present a case of type 1 AIP with histologically proven LPSP with GELs. This patient had neither serum IgG4 elevation nor MPD narrowing. In this case, the clinically and histologically atypical findings for type 1 AIP are intriguing.

Prevalence and Clinicopathological Features of Autoimmune Pancreatitis in Japanese Patients With Inflammatory Bowel Disease

“…18 The frequency of IBD in type 1 and type 2 AIP patients in Europe and North America were 2% to 4% and 4% to 31%, respectively, and 0% to 33% in Korea. 8,20,21 In 1 patient in the present study, IgG4-positive plasma cells (3/HPF) infiltrated the lobule. In Asia, type 1 AIP patients with IBD may be rare.…”

Microscopic findings in EUS‐guided fine needle (SharkCore) biopsies with type 1 and type 2 autoimmune pancreatitis

“…Patient 3 had a slightly elevated serum IgG4 (179 mg/dL) but many GELs and focally up to nine IgG4‐positive cells per HPF in her LUS‐CNB. It may therefore be speculated that she could have an overlap type of AIP, according to recently published data suggesting this diagnosis in AIP patients who show a mix of the criteria for type 1 and type 2 AIP …”

“…It may therefore be speculated that she could have an overlap type of AIP, according to recently published data suggesting this diagnosis in AIP patients who show a mix of the criteria for type 1 and type 2 AIP. 12,13 Pancreatic core needle biopsies (CNBs) are difficult to obtain by EUS that requires a high technical expertise, even though a special biopsy needle, the tru-cut needle, was designed for this purpose. 15 Percutaneous CNBs are often very useful for the diagnosis of AIP but bear the risk of seeding in case of pancreatic cancer.…”

“…Hence, it is tempting to speculate that this patient might have overlap type of AIP, showing overlapping features of both type 1 and type 2 AIP, as suggested in a few published patients. 12,13 She stopped taking prednisolone 13 months after the initial EUS-FNB, and at last follow-up 3 months later, she had not developed any recurrences of AIP.…”

Особенности гистоструктуры поджелудочной железы при аутоиммунном панкреатите I и II типов: связь с уровнем IgG4-положительных плазматических клеток

“…Считается, что при этом типе АИП уровень сывороточного и тканевого IgG4 не повышается [5,6]. Однако описан случай атипичного АИП I, протекающего с лейкоцитарной инфильтрацией панкреатических протоков [7]. АИП II типа сочетается с хроническими воспалительными заболеваниями кишечника: неспецифическим язвенным колитом и болезнью Крона [3].…”