Treating patients with autoimmune pancreatitis: Results from a long-term follow-up study

Since the rediscovery and definition of autoimmune pancreatitis (AIP) by Yoshida et al. in 1995, the disease has been attracting attention because of its unique clinical features and practical issues. This disease shows very impressive imaging findings, serological changes, and characteristic histopathology. It occurs most commonly in elderly males with painless jaundice or mild abdominal pain; resemblance in imaging findings between AIP and pancreatobiliary cancers poses an important practical issue of differentiation. With increasing recognition of AIP and accumulation of cases, another important feature of this disease has been revealed, i.e

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“…Some reports show an appearance of pancreatic atrophy in 30-40% of AIP patients and pancreatic stones in 6.5-25% [103][104][105].…”

Section: Long-term Prognosismentioning

confidence: 99%

Autoimmune pancreatitis in Japan: overview and perspective

Shimosegawa

Kanno

2009

J Gastroenterol

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“…It often leads to unnecessary surgical resection, [1][2][3][4] which is particularly tragic given that this entity is now known to be rapidly and effectively treated by corticosteroid therapy. [5][6][7][8][9] Accordingly, preoperative biopsy diagnosis and medical treatment are highly sought after clinical goals. This study sheds further light on the issue by demonstrating the utility of two histologic features in combination, namely venous pathology as detected by Movat staining, in conjunction with increased pancreatic tissue IgG4-positive plasma cells by immunohistochemistry.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Steroid therapy has been shown to be highly and rapidly effective in the majority of cases, leading to resolution within weeks of pancreatic mass lesions, pancreatic and biliary obstruction, and symptoms of pain and pancreatic insufficiency. [5][6][7][8][9] Until recently, preoperative diagnosis and medical therapy were not available options, but emerging clinical and pathologic assays are changing this situation. The obvious therapeutic advantage of accurate diagnosis is critical and indicates the need for highly sensitive and specific markers.…”

mentioning

confidence: 99%

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

et al. 2009

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Autoimmune pancreatitis is highly responsive to steroid therapy, but because it mimics pancreatic cancer, it often precipitates unnecessary surgery. Adequate diagnostic tests are needed to permit appropriate medical therapy. Lymphocytic and obliterative phlebitis are reported in the majority of cases, as are elevated IgG4-positive plasma cells, indicating their high sensitivity. Their specificities, especially when used in conjunction, however, remain largely unknown. Movat pentachrome vascular and IgG4 immunohistochemical stains were performed on a total of 15 autoimmune pancreatitis cases (11 pancreatic resections and 4 biopsies), 39 usualtype alcoholic or idiopathic chronic pancreatitis cases, 35 pancreatic ductal adenocarcinoma-associated chronic pancreatitis cases, and 29 normal pancreata. Marked and diffuse lymphocytic and obliterative venulitis were detected in all 15 cases of autoimmune pancreatitis on Movat staining (100% sensitivity). Only a single carcinoma-associated chronic pancreatitis case among all of the controls showed diffuse benign venulitis that was nonobliterative (99% specificity). Nine of 13, 9 autoimmune pancreatitis cases showed marked IgG4 immunopositivity at X10 positive plasma cells per Â 400 field (69% sensitivity). No increased IgG4 plasma cells were found in any of 103 controls (100% specificity). In combination, all of the autoimmune pancreatitis cases had at least one (13/13) and most had both markers (9/13), whereas none of the controls had both markers. Overall, these combined stains show very promising diagnostic utility and should be considered in combination with clinical and serologic analyses in the evaluation of chronic pancreatitis suspicious for malignancy. Future validating studies on preoperative biopsies with outcome data following steroid therapy will be essential.

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“…9) (37,45). Igualmente se ha descrito que en las fases iniciales de la enfermedad la existencia de alteraciones pancreáticas exocrinas y endocrinas tiende a normalizarse tras el tratamiento con corticosteroides (61); sin embargo en las fases avanzadas, con intensa fibrosis, los cambios tienden a ser permanentes (con atrofia pancreática, irregularidades pancreáticas) (37,62). Las manifestaciones extrapancreáticas igualmente ceden cuando la fibrosis no es intensa.…”

Section: Características Según La Respuesta a La Terapéuticaunclassified

“…Las series publicadas comprenden periodos de tiempo limitados con un número reducido de pacientes (62,(66)(67)(68)(69).…”

Section: Evolución a Largo Plazounclassified