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Isolated intrapancreatic Ig G4-related sclerosing cholangitis

World Journal of Gastroenterology 2015年第4期21卷 1334-1343页

作者： Takahiro Nakazawa Yushi Ikeda Yoshiaki Kawaguchi Hirohisa Kitagawa Hiroki Takada Yutaka Takeda Isamu Makino Naohiko Makino Itaru Naitoh Atsushi Tanaka Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical SciencesNagoya 467-8601Japan Department of Gastroenterology Yamagata University Faculty of MedicineYamagata 990-9585Japan Department of Gastroenterology Tokai University School of MedicineKanagawa 259-1153Japan Gastroenterologic Surgery Division of Cancer Medicine Graduate School of Medical ScienceKanazawa UniversityKanazawa 920-8640Japan Department of Gastroenterology Kasugai Municipal HospitalKasugai 486-8510Japan Department of Surgery Kansai Rosai HospitalOsaka 660-8511Japan Department of Medicine Teikyo University School of MedicineTokyo 173-8606Japan

Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is frequently associated with type 1 autoimmune pancreatitis(AIP). Association with AIP can be utilized in the diagnosis of Ig G4-SC. However, some cases of Ig G4-SC are isolated from AIP, which complicates the diagnosis. Most of the reported cases of isolated Ig G4-SC displayed hilar biliary strictures, whereas isolated Ig G4-SC with intrapancreatic biliary stricture is very rare. Recently, we have encountered 5 isolated intrapancreatic Ig G4-SC cases that were not associated with AIP, three of which were pathologically investigated after surgical operation. They all were males with a mean age of 74.2 years. The pancreas was not enlarged in any of these cases. No irregular narrowing of the main pancreatic duct was found. Bile duct wall thickening in lesions without luminal stenosis was detected by abdominal computed tomography in all five cases, by endoscopic ultrasonography in two out of four cases and by intraductal ultrasonography in all three cases. In three cases, serum Ig G4 levels were within the normal limits. The mean serum Ig G4 level measured before surgery was 202.1 mg/d L(4 cases). Isolated intrapancreatic Ig G4-SC is difficult to diagnose, especially if the Ig G4 level remains normal. Thus, this type of Ig G4-SC should be suspected in addition to cholangiocarcinoma and pancreatic cancer if stenosis of intrapancreatic bile duct is present.

关键词： Immunoglobulin G4-related sclerosing cholangitis I

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Clinicopathological study of primary biliary cirrhosis with nterface hepatitis compared to autoimmune hepatitis

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World Journal of Gastroenterology 2014年第13期20卷 3597-3608页

作者： Mio Kobayashi Yuko Kakuda Kenichi Harada Yasunori Sato Motoko Sasaki Hiroko Ikeda Mitsuhiro Terada Munenori Mukai Shuichi Kaneko Yasuni Nakanuma Department of Human Pathology Kanazawa University Graduate School of MedicineKanazawa 920-8640Japan Division of Pathology Kanazawa University HospitalKanazawa 920-8641Japan Department of Gastroenterology Kouseiren Takaoka HospitalTakaoka 933-8555Japan Department of Pathology Kouseiren Takaoka HospitalTakaoka 933-8555Japan Department of Gastroenterology Kanazawa University Graduate School of MedicineKanazawa 920-8640 Japan

AIM:To investigate histological and immunohistochemical differences in hepatitis between autoimmune hepatitis(AIH)and primary biliary cirrhosis(PBC)with AIH ***:Liver needle biopsies of 41 PBC with AIH features and 43 AIH patients were *** activity of periportal and lobular inflammation was scored0(none or minimal activity)to 4(severe),and the degree of hepatitic rosette formation and emperipolesis was semiquantatively scored *** infiltration of mononuclear cells positive for CD20,CD38,CD3,CD4,and CD8 and positive for immunoglobulins(IgG,IgM,and IgA)at the periportal areas(interface hepatitis)and in the hepatic lobules(lobular hepatitis)were semiquantitatively scored in immunostained liver sections(score 0-6).Serum aspartate aminotransferase(AST),immunoglobulins,and autoantibodies at the time of liver biopsy were correlated with the histological and immunohistochemical scores of individual ***:Lobular hepatitis,hepatitic rosette formation,and emperipolesis were more extensive and frequent in AIH than in ***3+,CD4+,and CD8+cell infiltration scores were higher in the hepatic lobules and at the interface in AIH but were also found in *** degree of mononuclear cell infiltration correlated well with the degree of interface and lobular hepatitis in PBC,but to a lesser degree in ***20+cells were mainly found in the portal tracts and,occasionally,at the interface in both *** AST correlated well with the hepatocyte necroinflammation and mononuclear cell infiltration,specifically CD38+cells in *** correlation existed between autoantibodies and inflammatory cell infiltration in PBC or *** most AIH cases were IgG-predominant at the interface,PBC cases were divided into IgM-predominant,IgM/IgGequal,and IgG-predominant types,with the latter sharing several features with ***:These results suggest that the hepatocellular injuries associated with interface and lobular hepatitis in AIH and PBC with inte

关键词： Primary biliary cirrhosis Autoimmune hepa-titis In

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