Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis Journal Article
| Authors: | Dhall, D.; Suriawinata, A. A.; Tang, L. H.; Shia, J.; Klimstra, D. S. |
| Article Title: | Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis |
| Abstract: | The patients with autoimmune pancreatitis usually present with jaundice and a pancreatic head mass, presumed to have pancreatic cancer, and they often undergo pancreatic resection. Elevated serum IgG4 levels (>135 mg/dL) help to distinguish autoimmune pancreatitis from pancreatic cancer. However, when the biopsy from a pancreatic mass shows dense chronic inflammation and fibrosis and the serum IgG4 level is not available, it presents a diagnostic dilemma whether it represents autoimmune pancreatitis or peritumoral pancreatitis. We performed IgG4 immunohistochemistry on 25 cases of autoimmune pancreatitis-lymphoplasmacytic sclerosing pancreatitis, 7 cases of autoimmune pancreatitis with granulocytic epithelial lesions, 8 cases of nonspecific pancreatitis, 15 cases of pancreatitis associated with pancreatic ductal adenocarcinoma, and 5 biopsies of pancreatic adenocarcinoma with variable inflammation. The distribution of IgG4-positive cells was noted in each case. Eighty-four percent (21/25) of autoimmune pancreatitis-LPSP cases showed diffuse and dense staining for IgG4, with more than 50 positive plasma cells per high-power field (range, 50-150 cells/hpf) in the highest density area. Most (5/7) cases of autoimmune pancreatitis-granulocytic epithelial lesions were negative for IgG4. Thirty-nine percent of nonspecific pancreatitis and peritumoral pancreatitis cases stained positive for IgG4, but the distribution was focal and none of the cases showed more than 50 IgG4-positive cells/hpf in the highest density area of IgG4 staining. IgG4-positive cells in peritumoral pancreatitis and nonspecific pancreatitis cases were closely associated with malignant glands and areas of acute inflammation in some cases. Using a cutoff of 50 IgG4-positive cells/hpf, the sensitivity of IgG4 staining for classical autoimmune pancreatitis-LPSP versus other types of pancreatitis was 84%, the specificity was 100%, and the P value was significant (<.0001). Hence, we conclude that diffuse and dense staining (>50 positive cells/hpf) for IgG4 is specifically seen in autoimmune pancreatitis-LPSP, and IgG4 staining along with the histologic features and serum IgG4 levels may be very helpful in diagnosing autoimmune pancreatitis. © 2010 Elsevier Inc. All rights reserved. |
| Keywords: | immunohistochemistry; adolescent; adult; clinical article; human tissue; aged; aged, 80 and over; middle aged; pancreatic neoplasms; pancreas; t lymphocyte; disease association; diagnosis, differential; carcinoma, pancreatic ductal; b lymphocyte; immunoglobulin g; pancreatitis; chronic pancreatitis; pancreas adenocarcinoma; antigens, cd; autoimmune diseases; immunoglobulin blood level; pancreas biopsy; immunoglobulin g4; plasma cells; autoimmune pancreatitis; igg4; lymphoplasmacytic sclerosing pancreatitis; peritumoral pancreatitis |
| Journal Title: | Human Pathology |
| Volume: | 41 |
| ISSN: | 0046-8177 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2010-01-01 |
| Start Page: | 643 |
| End Page: | 652 |
| Language: | English |
| DOI: | 10.1016/j.humpath.2009.10.019 |
| PUBMED: | 20149413 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 5" - "Export Date: 20 April 2011" - "CODEN: HPCQA" - "Source: Scopus" |
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23Dhall -
19
Suriawinata -
978Klimstra -
717Shia -
447Tang
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