journal of Histology & Histopathology

Journal of Histology & Histopathology

ISSN 2055-091X
Original Research

Title-autoimmune pancreatitis in pancreatic resections done for presumed pancreatic malignancies-An experience of tertiary centre from North India

Ritambhra Nada1*, Rajesh Gupta2, D K Bhasin3, S S. Rana3, L Kaman2, T D Yadav2, Ashwani Kumar1 and Kusum Joshi1

*Correspondence: Ritambhra Nada ritamduseja@yahoo.com

1. Departments of Histopathology, Postgraduate Institute of Medical Education and Research, India.

Author Affiliations

2. Department of Surgery, Postgraduate Institute of Medical Education and Research, India.

3. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, India.

Abstract

Background: Autoimmune pancreatitis (AIP) can present as pancreatic mass mimicking malignancy. However, it has specific histomorphology and immunohistology which in clinical context can be diagnostic.

Aim: To retrospectively analyze pancreatic resections done for pancreatic head masses to identify cases of autoimmune pancreatitis.

Methods: Hematoxylin and eosin stained slides of pancreatic resections (n-42) done for pancreatic masses (2004-2012) were reviewed. Immunohistochemistry for IgG4 was done in cases suggestive of AIP. As controls, 30 pancreatic carcinomas (n-30) and plasma cells rich chronic pancreatitis (n-25) were stained with IgG4. Clinical records were retrieved.

Results: There were 5/142 cases (3.5%) of autoimmune pancreatitis among pancreatic resections done for presumed pancreatic tumors. There were 3 females and 2 males and age range was 35-65 (mean 51). Presenting symptoms were painless jaundice (n-4), with adult onset diabetes (n-1) and feature of gastric outlet obstruction (n-1). Histomorphology of all the five masses was of Type I autoimmune pancreatitis showing lobulocentric plasma cell rich inflammation and storiform fibrosis. IgG4 positive plasma cells (>10 per high power field) in all the cases diagnosed as autoimmune pancreatitis; though few IgG4 positive plasma cells were positive in controls. Venulitis and veno-oblitrative changes, neural hyperplasia, neuritis were present in all. Serum IgG4 levels done immediately after surgeries in three patients were elevated.

Conclusion: Incidence of autoimmune pancreatitis in pancreatic resections done for pancreatic masses is 3.5%. All the five cases were of Type 1 autoimmune pancreatitis with significant number of IgG4 positive plasma cells using >10 positive cells per high power field as cut off.

Keywords: Autoimmune, IgG4 positive plasma cells, pancreatitis, pancreatic masses

ISSN 2055-091X
Volume 1
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