Guidance for diagnosing autoimmune pancreatitis with biopsy tissues
Guidance for diagnosing autoimmune pancreatitis with biopsy tissues
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DOI：
10.1111/pin.12994
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发表时间：
2020-08-06
影响因子：
2.2
通讯作者：
Okazaki, Kazuichi
中科院分区：
文献类型：
--
作者：
Notohara, Kenji;Kamisawa, Terumi;Okazaki, Kazuichi
基于活检的自身免疫性胰腺炎（AIP）的诊断是困难的，但由于内镜超声引导活检组织的数量增加，病理学家变得势在必行。为了科普这一挑战，我们提出了1型AIP的活检诊断指南。本指南适用于病理学家，包括三个主要部分。第一部分包括组织采集、染色和最终诊断的基本问题，也适用于胃肠病学家。第二部分是基于2018年AIP临床诊断标准诊断1型AIP的实用指南。不一致的组织学检查结果，提示评估IgG4免疫染色和关键的组织学特征，包括导管病变和其他解释。血管纤维化和闭塞性静脉炎是诊断的标志，但有时是模棱两可的。梭形纤维化是指梭形细胞、炎性细胞和细小的胶原纤维形成流动排列。闭塞性静脉炎定义为伴有炎性细胞的纤维性静脉闭塞。每一个例子提供。第三部分描述了AIP与胰腺导管腺癌（PDAC）的鉴别，重点介绍了AIP中腺泡导管化生的组织学特征，AIP是PDAC的重要模拟物。本指南将有助于标准化胰腺活检病理报告，以诊断1型AIP。
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.