Diagnosis of Autoimmune Pancreatitis: The Mayo Clinic Experience

IgG4-related Autoimmune Prostatitis: Two Cases with or without Autoimmune Pancreatitis

“…Both cases showed significantly increased serum levels of IgG4, reported to be a serological marker of AIP (5). Indeed, case 1 was complicated with AIP and showed typical findings of the pancreatic imaging study, such as diffuse enlargement of the pancreas and irregular narrowing of the main pancreatic duct (2,4,15). In addition, FDG-PET(-CT) revealed significant uptake of FDG by the pancreas in case 1; the same finding has been reported in AIP (19,20 …”

“…Characteristic findings on the pancreatic imaging studies and a remarkably increased level of serum IgG4 fulfilled the diagnostic criteria for AIP proposed by a Japanese group (14) and a group at the Mayo Clinic (15). Accordingly, we started to treat the patient with 40 mg/day of oral prednisolone (PSL) and then tapered this dose by 5 mg every two weeks.…”

Histopathological findings in 29 lymph node biopsies with increased IgG4 plasma cells

“…Six cases (Cases 1, 5, 13, 14, 18 , 27; Table 2) were tested for human herpes virus 8 (HHV8) by immunohistochemical staining and were negative. S100 staining was done in four cases (2,3,9,18); one case was also tested for CD1a (Case 2) showing co-expression of S-100 protein and CD1a staining on increased scattered Langerhans cells. Features of Rosai-Dorfman disease were not seen.…”

“…Originally described as a unique form of autoimmune pancreatitis, 1 IgG4-related sclerosing pancreatitis was typically encountered in older males with a striking clinical mimicry of pancreatic carcinoma, frequent relapse, elevated serum IgG4 levels and a marked response to steroid therapy. [1][2][3] Histological findings demonstrated a combination of fibrosis and lymphoplasmacytic infiltrate with increased numbers of IgG4 plasma cells. 4 More recently, we have come to understand that the pancreatic disease was only one of the many manifestations of this disease.…”

The role of Movat pentachrome stain and immunoglobulin G4 immunostaining in the diagnosis of autoimmune pancreatitis

“…An accepted histologic feature of autoimmune pancreatitis is lymphocytic venulitis, as included in the Mayo Clinic diagnostic criteria, 22 whereby lymphocytes surround and infiltrate the walls of medium to large-sized pancreatic veins and may lead to occlusive obliteration or destruction of the vessels (Figure 1a and b). Movat staining amplifies the detection of venulitis and obliterative change in autoimmune pancreatitis many fold over H&E staining alone.…”