Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

Kenji Notohara¹, Terumi Kamisawa², Noriyoshi Fukushima³, Toru Furukawa⁴, Takuma Tajiri⁵, Hiroshi Yamaguchi⁶, Shinichi Aishima⁷, Yuki Fukumura⁸, Kenichi Hirabayashi⁹, Eisuke Iwasaki¹⁰, Atsushi Kanno^{11

12}, Satomi Kasashima¹³, Atsuhiro Kawashima¹⁴, Motohiro Kojima¹⁵, Kensuke Kubota¹⁶, Yasuhiro Kuraishi¹⁷, Tomoko Mitsuhashi¹⁸, Yoshiki Naito¹⁹, Itaru Naitoh²⁰, Hiroshi Nakase²¹, Takayoshi Nishino²², Nobuyuki Ohike²³, Junichi Sakagami^{24

25}, Kyoko Shimizu²⁶, Masahiro Shiokawa²⁷, Takeshi Uehara²⁸, Tsukasa Ikeura²⁹, Shigeyuki Kawa³⁰, Kazuichi Okazaki³¹

Affiliations

¹ Department of Anatomic Pathology, Kurashiki Central Hospital, Okayama, Japan.
² Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
³ Department of Pathology, Jichi Medical University, Tochigi, Japan.
⁴ Department of Histopathology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
⁵ Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan.
⁶ Department of Pathology, Saitama Medical University, Saitama, Japan.
⁷ Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan.
⁸ Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
⁹ Department of Pathology, Tokai University School of Medicine, Tokyo, Japan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
¹¹ Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
¹² Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
¹³ Department of Clinical Laboratory Science, Kanazawa University, Ishikawa, Japan.
¹⁴ Department of Diagnostic Pathology, National Hospital Organization Kanazawa Medical Center, Ishikawa, Japan.
¹⁵ Division of Pathology, Research Center for Innovative Oncology, National Cancer Center, Chiba, Japan.
¹⁶ Depatment of Endoscopy, Yokohama City University Hospital, Kanagawa, Japan.
¹⁷ Department of Gastroenterology, Shinshu University School of Medicine, Nagano, Japan.
¹⁸ Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan.
¹⁹ Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
²⁰ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
²¹ Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Hokkaido, Japan.
²² Department of Gastroenterology, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan.
²³ Department of Pathology, Showa University Fujigaoka Hospital, Kanagawa, Japan.
²⁴ Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
²⁵ Fukuchiyama City Hospital, Kyoto, Japan.
²⁶ Department of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²⁷ Department of Gastroenterology, Kyoto University Hospital, Kyoto, Japan.
²⁸ Department of Laboratory Medicine, Shinshu University School of Medicine, Nagano, Japan.
²⁹ Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
³⁰ Department of Internal Medicine, Matsumoto Dental University, Nagano, Japan.
³¹ Kansai Medical University Kouri Hospital, Osaka, Japan.

PMID: 32767550
DOI: 10.1111/pin.12994

Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

Kenji Notohara et al. Pathol Int. 2020 Oct.

. 2020 Oct;70(10):699-711.

doi: 10.1111/pin.12994. Epub 2020 Aug 6.

Authors

Affiliations

¹ Department of Anatomic Pathology, Kurashiki Central Hospital, Okayama, Japan.
² Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
³ Department of Pathology, Jichi Medical University, Tochigi, Japan.
⁴ Department of Histopathology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
⁵ Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan.
⁶ Department of Pathology, Saitama Medical University, Saitama, Japan.
⁷ Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan.
⁸ Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
⁹ Department of Pathology, Tokai University School of Medicine, Tokyo, Japan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
¹¹ Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
¹² Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
¹³ Department of Clinical Laboratory Science, Kanazawa University, Ishikawa, Japan.
¹⁴ Department of Diagnostic Pathology, National Hospital Organization Kanazawa Medical Center, Ishikawa, Japan.
¹⁵ Division of Pathology, Research Center for Innovative Oncology, National Cancer Center, Chiba, Japan.
¹⁶ Depatment of Endoscopy, Yokohama City University Hospital, Kanagawa, Japan.
¹⁷ Department of Gastroenterology, Shinshu University School of Medicine, Nagano, Japan.
¹⁸ Department of Surgical Pathology, Hokkaido University Hospital, Hokkaido, Japan.
¹⁹ Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
²⁰ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
²¹ Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Hokkaido, Japan.
²² Department of Gastroenterology, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan.
²³ Department of Pathology, Showa University Fujigaoka Hospital, Kanagawa, Japan.
²⁴ Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
²⁵ Fukuchiyama City Hospital, Kyoto, Japan.
²⁶ Department of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²⁷ Department of Gastroenterology, Kyoto University Hospital, Kyoto, Japan.
²⁸ Department of Laboratory Medicine, Shinshu University School of Medicine, Nagano, Japan.
²⁹ Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
³⁰ Department of Internal Medicine, Matsumoto Dental University, Nagano, Japan.
³¹ Kansai Medical University Kouri Hospital, Osaka, Japan.

PMID: 32767550
DOI: 10.1111/pin.12994

Abstract

The biopsy-based diagnosis of autoimmune pancreatitis (AIP) is difficult but is becoming imperative for pathologists due to the increased amount of endoscopic ultrasound-guided biopsy tissue. To cope with this challenge, we propose guidance for the biopsy diagnosis of type 1 AIP. This guidance is for pathologists and comprises three main parts. The first part includes basic issues on tissue acquisition, staining, and final diagnosis, and is intended for gastroenterologists as well. The second part is a practical guide for diagnosing type 1 AIP based on the AIP clinical diagnostic criteria 2018. Inconsistent histological findings, tips for evaluating IgG4 immunostaining and key histological features including the ductal lesion and others are explained. Storiform fibrosis and obliterative phlebitis are diagnostic hallmarks but are sometimes equivocal. Storiform fibrosis is defined as spindle-shaped cells, inflammatory cells and fine collagen fibers forming a flowing arrangement. Obliterative phlebitis is defined as fibrous venous obliteration with inflammatory cells. Examples of each are provided. The third part describes the differentiation of AIP from pancreatic ductal adenocarcinoma (PDAC), focusing on histological features of acinar-ductal metaplasia in AIP, which is an important mimicker of PDAC. This guidance will help standardize pathology reports of pancreatic biopsies for diagnosing type 1 AIP.

Keywords: IgG4-related disease; autoimmune pancreatitis; biopsy; endoscopic ultrasound-guided fine needle aspiration; immunohistochemistry; pancreatic carcinoma; pathology.

PubMed Disclaimer

References

REFERENCES

1. Shimosegawa T, Chari ST, Frulloni L et al. International consensus diagnostic criteria for autoimmune pancreatitis: Guidelines of the International Association of Pancreatology. Pancreas 2011; 40: 352-58.
1. The Japan Pancreas Society. The Research Program on Intractable Diseases from the Ministry of Labour and Welfare of Japan. Japanese Clinical Diagnostic Criteria for Autoimmune Pancreatitis, 2018 (Proposal); Revision of Japanese Clinical Diagnostic Criteria for Autoimmune Pancreatitis, 2011. J Jpn Panc Soc 2018; 33: 902-13. in Japanese.
1. Kawa S, Kamisawa T, Notohara K et al. Japanese Clinical Diagnostic Criteria for Autoimmune Pancreatitis, 2018: Revision of Japanese Clinical Diagnostic Criteria for Autoimmune Pancreatitis, 2011. Pancreas 2020; 49: e13-e14.
1. Kawaguchi K, Koike M, Tsuruta K, Okamoto A, Tabata I, Fujita N. Lymphoplasmacytic sclerosing pancreatitis with cholangitis: A variant of primary sclerosing cholangitis extensively involving pancreas. Hum Pathol 1991; 22: 387-95.
1. Notohara K, Burgart LJ, Yadav D, Chari S, Smyrk TC. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: Clinicopathologic features of 35 cases. Am J Surg Pathol 2003; 27: 1119-27.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

Health and Labour Sciences Research Grants (Intractable Diseases)/Ministry of Health, Labour and Welfare

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

Affiliations

Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous