TY - JOUR
T1 - Guidance for diagnosing autoimmune pancreatitis with biopsy tissues
AU - Notohara, Kenji
AU - Kamisawa, Terumi
AU - Fukushima, Noriyoshi
AU - Furukawa, Toru
AU - Tajiri, Takuma
AU - Yamaguchi, Hiroshi
AU - Aishima, Shinichi
AU - Fukumura, Yuki
AU - Hirabayashi, Kenichi
AU - Iwasaki, Eisuke
AU - Kanno, Atsushi
AU - Kasashima, Satomi
AU - Kawashima, Atsuhiro
AU - Kojima, Motohiro
AU - Kubota, Kensuke
AU - Kuraishi, Yasuhiro
AU - Mitsuhashi, Tomoko
AU - Naito, Yoshiki
AU - Naitoh, Itaru
AU - Nakase, Hiroshi
AU - Nishino, Takayoshi
AU - Ohike, Nobuyuki
AU - Sakagami, Junichi
AU - Shimizu, Kyoko
AU - Shiokawa, Masahiro
AU - Uehara, Takeshi
AU - Ikeura, Tsukasa
AU - Kawa, Shigeyuki
AU - Okazaki, Kazuichi
N1 - Funding Information:
The authors would like to thank the following physicians for their invaluable advice in the preparation of this guidance, in addition to their significant contributions to the selection and collection of data for the reference cases: Professor Yuzo Kodama, Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan; Dr. Masayo Motoya, Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan; Dr. Teruko Tomono, Department of Gastroenterology, Kyoto University Hospital, Kyoto, Japan. This work was supported by Health and Labour Sciences Research Grants (Intractable Diseases) from Japan's Ministry of Health, Labour and Welfare.
Publisher Copyright:
© 2020 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd
PY - 2020/10/1
Y1 - 2020/10/1
N2 - 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.
AB - 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.
KW - IgG4-related disease
KW - autoimmune pancreatitis
KW - biopsy
KW - endoscopic ultrasound-guided fine needle aspiration
KW - immunohistochemistry
KW - pancreatic carcinoma
KW - pathology
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U2 - 10.1111/pin.12994
DO - 10.1111/pin.12994
M3 - Review article
C2 - 32767550
AN - SCOPUS:85089076673
SN - 1320-5463
VL - 70
SP - 699
EP - 711
JO - Pathology international
JF - Pathology international
IS - 10
ER -