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. 2022 Oct 12;12(10):2464.
doi: 10.3390/diagnostics12102464.

Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy for Histological Diagnosis of Type 2 Autoimmune Pancreatitis

Hidehiro Hayashi  1 , Shin Miura  1 , Fumiyoshi Fujishima  2 , Shimpei Kuniyoshi  2 , Kiyoshi Kume  1 , Kazuhiro Kikuta  1 , Shin Hamada  1 , Tetsuya Takikawa  1 , Ryotaro Matsumoto  1 , Mio Ikeda  1 , Takanori Sano  1 , Fumiya Kataoka  1 , Akira Sasaki  1 , Misako Sakano  1 , Atsushi Masamune  1
Affiliations

Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy for Histological Diagnosis of Type 2 Autoimmune Pancreatitis

Hidehiro Hayashi et al. Diagnostics (Basel). .

Abstract

In Japan, type 1 autoimmune pancreatitis (AIP) is the most common type of AIP; type 2 AIP is rare. The aim of this study was to clarify the usefulness of endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNAB) for the diagnosis of type 2 AIP. We analyzed the tissue specimens of 10 patients with suspected type 2 AIP who underwent EUS-FNAB at our hospital between April 2009 and March 2021 for tissue volume and histopathological diagnostic performance. The male-to-female ratio of the patients was 8:2, and the patient age (mean ± standard deviation) was 35.6 ± 15.5 years. EUS-FNAB provided sufficient tissue volume, with high-power field >10 in eight patients (80.0%). Based on the International Consensus Diagnostic Criteria (ICDC), four patients (40.0%) had histological findings corresponding to ICDC level 1, and five patients (50.0%) had histological findings corresponding to ICDC level 2. The results of this study show that EUS-FNB can be considered an alternative method to resection and core-needle biopsy for the collection of tissue samples of type 2 AIP.

Keywords: International Consensus Diagnostic Criteria; granulocytic epithelial lesions; inflammatory bowel disease; main pancreatic duct narrowing; ulcerative colitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Processing of histological specimens. (A) Tubular tissue fragments and bloody liquid components extruded onto a glass slide. (B) Ductal tissue pieces separated into white-toned and red-toned pancreatic tissues using 18-G disposable needles. (C) White-toned and red-toned pancreatic tissues transferred into separate formalin-filled containers.
Figure 2
Figure 2
Histopathological tissue obtained using EUS-FNB from a patient with a confirmed diagnosis of type 2 autoimmune pancreatitis. (A,B) Histological examination of specimens showing GELs (arrowhead, hematoxylin–eosin stain, ×40).
Figure 3
Figure 3
Image findings of case 10. (A–C) Computed tomography (CT) showing diffuse pancreatic enlargement. (D–F) Endoscopic ultrasound showing diffuse pancreatic enlargement and a mass in the pancreatic head. (G) Magnetic resonance imaging showing intrapancreatic bile duct stenosis and MPD narrowing. (H,I) Endoscopic retrograde cholangiopancreatography (ERCP) showing MPD narrowing and intrapancreatic bile duct stenosis.
Figure 4
Figure 4
Histopathological tissue from case 10 obtained using EUS-FNB. (A) Loupe image of specimen obtained using EUS-FNB showing adequate amount of tissue (hematoxylin–eosin stain) (B) Microscopic image showing neutrophilic infiltration of pancreatic parenchyma (hematoxylin–eosin stain, ×10). (C) Microscopic image showing GELs (arrowhead, hematoxylin–eosin stain, ×40). (D) IgG immunostaining showing IgG-positive cells (×10). (E) IgG4 immunostaining showing a few IgG4-positive cells (×10). (F) Elastica–Masson staining showing no obstructive phlebitis (×10). (G) Cluster of differentiation 38 immunostaining showing plasma cells (×10).
Figure 5
Figure 5
Imaging findings after steroid introduction. (A–C) CT. (D) Magnetic resonance cholangiopancreatography. (E,F) ERCP. Pancreatic enlargement, MPD stenosis, and bile duct stricture all improved after steroid introduction.
See this image and copyright information in PMC

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