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. 2006 Jun 21;12(23):3736-9.
doi: 10.3748/wjg.v12.i23.3736.

Sclerosing cholecystitis associated with autoimmune pancreatitis

Terumi Kamisawa  1 , Yuyang Tu, Hitoshi Nakajima, Naoto Egawa, Kouji Tsuruta, Atsutake Okamoto, Shinichirou Horiguchi
Affiliations

Sclerosing cholecystitis associated with autoimmune pancreatitis

Terumi Kamisawa et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the histopathological and radiological findings of the gallbladder in patients with autoimmune pancreatitis (AIP).

Methods: The radiological findings of the gallbladder of 19 AIP patients were retrospectively reviewed. Resected gallbladders of 8 AIP patients were examined histologically and were immunostained with anti-IgG4 antibody. Controls consisted of gallbladders resected for symptomatic gallstones (n = 10) and those removed during pancreatoduodenectomy for pancreatic carcinoma (n = 10), as well as extrahepatic bile ducts and pancreases removed by pancreatoduodenectomy for pancreatic carcinoma (n = 10).

Results: Thickening of the gallbladder wall was detected by ultrasound and/or computed tomography in 10 patients with AIP (3 severe and 7 moderate); in these patients severe stenosis of the extrahepatic bile duct was also noted. Histologically, thickening of the gallbladder was detected in 6 of 8 (75%) patients with AIP; 4 cases had transmural lymphoplasmacytic infiltration with fibrosis, and 2 cases had mucosal-based lymphoplasmacytic infiltration. Considerable transmural thickening of the extrahepatic bile duct wall with dense fibrosis and diffuse lymphoplasmacytic infiltration was detected in 7 patients. Immunohistochemically, severe or moderate infiltration of IgG4-positive plasma cells was detected in the gallbladder, bile duct, and pancreas of all 8 patients, but was not detected in controls.

Conclusion: Gallbladder wall thickening with fibrosis and abundant infiltration of IgG4-positive plasma cells is frequently detected in patients with AIP. We propose the use of a new term, sclerosing cholecystitis, for these cases that are induced by the same mechanism as sclerosing pancreatitis or sclerosing cholangitis in AIP.

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Figures

Figure 1
Figure 1
Severe thicke-ning of the gallbladder wall in a patient with autoimmune pancreatitis on US.
Figure 2
Figure 2
Moderate thic-kening of the gallbladder wall in a patient with autoimmune pancreatitis on US.
Figure 3
Figure 3
Transmural lymphopla-smacytic infiltration with fibrosis in the gallbladder wall of a patient with autoimmune pancreatitis.
Figure 4
Figure 4
Severe infiltration of IgG4-positive plasma cells in the gallbladder wall of a patient with autoimmune pancreatitis.
See this image and copyright information in PMC

References

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