Chronic pancreatitis, pseudotumors and other tumor-like lesions

Klöppel, Günter

doi:10.1038/modpathol.3800690

Cited by 158 publications

(119 citation statements)

References 115 publications

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“…LPSP, also called as type 1 AIP, is characterized histologically by dense lymphoplasmacytic infiltration, marked storiform fibrosis, and obliterative phlebitis [10]. These findings are associated with large-and medium-sized interlobular ducts [2,9]. In addition to IgG4 + plasma cells, lymphoplasmacytic infiltration in type 1 AIP consists mainly of T cells [7], including T helper 2 (Th2) and regulatory T (Treg) [11] cells.…”

Section: Introductionmentioning

confidence: 99%

“…Autoimmune pancreatitis (AIP) is a chronic, relapsing inflammatory disorder commonly affecting the head of the pancreas and often resulting in stenosis/obstruction of the main pancreatic duct with obstructive jaundice [1,2]. Yoshida et al characterized AIP in 1995 [3], but it was not until in 2001 that Hamano et al observed elevated levels of serum IgG4 in AIP [4].…”

Section: Introductionmentioning

confidence: 99%

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Periductal Induction of High Endothelial Venule-Like Vessels in Type 1 Autoimmune Pancreatitis

Maruyama¹,

Kobayashi²,

Sakai³

et al. 2013

Pancreas

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Objectives: Type 1 autoimmune pancreatitis (AIP) is histologically characterized by dense lymphoplasmacytic infiltration and marked storiform fibrosis, manifestations associated with pancreatic ducts. Such periductal lymphocyte recruitment is thought to be elicited by dysregulation of mechanisms governing physiological lymphocyte homing. The present study was undertaken to determine whether vascular addressins including peripheral lymph node addressin (PNAd) and mucosal addressin cell adhesion molecule 1 (MAdCAM-1) play a role in type 1 AIP histogenesis.Methods: Tissue sections of type 1 AIP and tumor-associated non-AIP chronic pancreatitis, as well as normal pancreas, were subjected to immunohistochemical analysis using vascular addressin-related antibodies.Results: The number of periductal MECA-79 + high endothelial venule (HEV)-like vessels was increased in type 1 AIP relative to that seen in non-AIP chronic pancreatitis, while the number of MAdCAM-1 + HEV-like vessels did not differ between the two conditions. MECA-79 antigens are expressed on duct-forming epithelial cells not only in pancreas but also in salivary glands, which often harbor extrapancreatic lesions in type 1 AIP.Conclusions: Type 1 AIP can be characterized by periductal induction of MECA-79 + HEV-like vessels.MECA-79 + 6-sulfo sialyl Lewis X-related carbohydrate antigens expressed on duct-forming epithelial 3 cells could be associated with type 1 AIP pathogenesis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Periductal Induction of High Endothelial Venule-Like Vessels in Type 1 Autoimmune Pancreatitis

Maruyama¹,

Kobayashi²,

Sakai³

et al. 2013

Pancreas

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“…Indeed, in 2 cases out of the presented series, we observed the same histological picture including cystic degeneration in the paraduodenal portion of the pancreas with otherwise normal surrounding pancreatic tissue. This change logically led to the concept of chronic pancreatitis associated with anatomic abnormalities and a history of alcohol abuse [20]. In a recent published study of 105 cases of CDHP, Rebours et al [14] concluded that CDHP may arise in patients with or without chronic pancreatitis and with or without chronic alcoholism.…”

Section: Discussionmentioning

confidence: 99%

Cystic Dystrophy in Heterotopic Pancreas of the Duodenal Wall

Jovanović¹,

Alempijević²,

Lukić³

et al. 2008

Dig Surg

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Background: Cystic dystrophy in heterotopic pancreas (CDHP) is a rare condition. It has been recently reported as one of the etiologic obstructive factors of chronic pancreatitis. The aim of our study was to evaluate diagnosis and management of CDHP in the duodenal wall in a surgical series. Methods: We retrospectively reviewed 13 patients with available clinical data. Results: There were 11 male and 2 female patients, median age 42 years. The average duration of symptoms was 7.5 months. 6 of them (46%) were alcoholics, and 10 (75%) had signs of chronic pancreatitis. Almost all of them (12/13; 92%) revealed disabling pain, while 4 (31%) had associated jaundice. In 4 of 7 patients (57%), weight loss was observed. Most often the patients were suspected of having pancreatic head mass with or without signs of chronic pancreatitis. All patients underwent surgical treatment. Pathological examination showed the presence of cysts surrounded by inflammation and fibrosis in the duodenal wall, as well as the presence of chronic pancreatitis in the pancreas proper. Conclusions: Cystic dystrophy of the duodenal wall represents a significant proportion of patients undergoing surgery for chronic pancreatitis. Pancreatoduodenectomy is the best therapeutic option.

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“…AIP has two distinct typestype 1, is lymphoplasmacytic sclerosing pancreatitis presenting with diffuse swelling of the pancreas, raised serum levels of IgG, frequently associated with other autoimmune-related diseases [4][5][6]. AIP type 2 presents in younger age group and has pathognomonic duct-centric pancreatitis [7]. AIP commonly presents as a pancreatic mass that mimics pancreatic ductal adenocarcinoma, obstructive jaundice due to the structuring of intrapancreatic portion of common bile duct, hilum and intrahepatic ducts is also common [4].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune pancreatitis : An entity difficult to diagnose

Kuntal¹,

Nangarwal²,

Meel³

et al. 2017

Int J Surg Med

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Background: Autoimmune pancreatitis is a sclerosing disorder characterized by autoimmune serology and multiple organ involvements, considered a disease of the western world, but now its incidence in India is rising because of increased awareness and development of clinicoradiological criteria to diagnose it. Case summary: A 60-years-old lady presented with pain abdomen, loss of weight, yellowish discolouration of skin and eyes. Her biochemical investigations revealed deranged liver function tests and raised erythrocyte sedimentation rate. Subsequent imaging showed bulky pancreatic head and an ill-defined hypodense mass lesion in it causing bi-lobar intrahepatic biliary dilatation. Based on the pre-operative diagnosis of carcinoma head of pancreas she underwent Whipple's procedure. To our surprise, histopathological examination confirmed this as autoimmune pancreatitis. Conclusion: Inflammatory pseudotumors have frequently been mistaken as pancreatic tumours and resected surgically. Since autoimmune pancreatitis responds dramatically to steroid therapy, accurate diagnosis can avoid major surgical undertakings like pancreatic resection.

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Chronic pancreatitis, pseudotumors and other tumor-like lesions

Cited by 158 publications

References 115 publications

Periductal Induction of High Endothelial Venule-Like Vessels in Type 1 Autoimmune Pancreatitis

Periductal Induction of High Endothelial Venule-Like Vessels in Type 1 Autoimmune Pancreatitis

Cystic Dystrophy in Heterotopic Pancreas of the Duodenal Wall

Autoimmune pancreatitis : An entity difficult to diagnose

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