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Digestive Diseases and Sciences

, Volume 56, Issue 5, pp 1290–1294 | Cite as

IgG4-Associated Cholecystitis: Another Clue in the Diagnosis of Autoimmune Pancreatitis

  • Michael D. Leise
  • Thomas C. Smyrk
  • Naoki Takahashi
  • Seth R. Sweetser
  • Santhi S. Vege
  • Suresh T. Chari
Review

Abstract

Purpose

Autoimmune pancreatitis (AIP) is the pancreatic manifestation of IgG4-associated systemic disease (ISD). Criteria for diagnosis of AIP include recognition of extra-pancreatic organ involvement. Because the diagnosis of AIP can be challenging, even for experts, it is important for clinicians to recognize other target organ damage in this disease. Typical gallbladder findings in AIP have been increasingly recognized. Because cholecystectomy is common in the community, the availability of previous tissue from the gallbladder can provide an important supportive clue in the diagnosis of AIP. The objective of this review is to examine the literature on common gallbladder pathology findings in AIP, and discuss their clinical utility.

Results

Gallbladder involvement in AIP seems to be common. Transmural lymphoplasmacytic inflammatory infiltrates, extramural inflammatory nodules, the presence of tissue eosinophilia, phlebitis, and increased tissue IgG4 are all seen more frequently in the gallbladders of patients with AIP. These findings are not 100% specific, because some can be seen in primary sclerosing cholangitis and pancreatic adenocarcinoma.

Conclusion

Cholecystectomy for the purpose of diagnosing AIP is not recommended. However, if gallbladder specimens from a previous cholecystectomy are available, an expert review of gallbladder slides with IgG4 immunostaining may help to provide additional criteria for diagnosis of autoimmune pancreatitis.

Keywords

Autoimmune pancreatitis IgG4-associated systemic disease IgG4 Gallbladder 

References

  1. 1.
    Gardner TB, Levy MJ, Takahashi N, Smyrk TC, Chari ST. Misdiagnosis of autoimmune pancreatitis: a caution to clinicians. Am J Gastroenterol. 2009;104:1620–1623.PubMedCrossRefGoogle Scholar
  2. 2.
    Deshpande V, Chicano S, Finkelberg D, et al. Autoimmune pancreatitis: a systemic immune complex mediated disease. Am J Surg Pathol. 2006;30:1537–1545.PubMedCrossRefGoogle Scholar
  3. 3.
    Detlefsen S, Drewes AM. Autoimmune pancreatitis. Scand J Gastroenterol. 2009;44:1391–1407.PubMedCrossRefGoogle Scholar
  4. 4.
    Leise MD, Jacobson KM, Chari ST. 75-year-old man with abdominal pain and weight loss. Mayo Clin Proc. 2008;83:1161–1164.PubMedCrossRefGoogle Scholar
  5. 5.
    Sarles H, Sarles JC, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas—an autonomous pancreatic disease? Am J Dig Dis. 1961;6:688–698.PubMedCrossRefGoogle Scholar
  6. 6.
    Ghazale A, Chari ST, Smyrk TC, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol. 2007;102:1646–1653.PubMedCrossRefGoogle Scholar
  7. 7.
    Okazaki K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41:626–631.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim MH, Kwon S. Diagnostic criteria for autoimmune chronic pancreatitis. J Gastroenterol. 2007;42(Suppl 18):42–49.PubMedCrossRefGoogle Scholar
  9. 9.
    Chari ST. Diagnosis of autoimmune pancreatitis using its five cardinal features: introducing the Mayo Clinic’s HISORt criteria. J Gastroenterol. 2007;42(Suppl 18):39–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Kamisawa T, Egawa N, Nakajima H. Autoimmune pancreatitis is a systemic autoimmune disease. Am J Gastroenterol. 2003;98:2811–2812.PubMedCrossRefGoogle Scholar
  11. 11.
    Kamisawa T, Okamoto A. IgG4-related sclerosing disease. World J Gastroenterol. 2008;14:3948–3955.PubMedCrossRefGoogle Scholar
  12. 12.
    Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–715.PubMedCrossRefGoogle Scholar
  13. 13.
    Cheung MT, Lo IL. IgG4-related sclerosing lymphoplasmacytic pancreatitis and cholangitis mimicking carcinoma of pancreas and Klatskin tumour. ANZ J Surg. 2008;78:252–256.PubMedCrossRefGoogle Scholar
  14. 14.
    Hamano H, Kawa S, Uehara T, et al. Immunoglobulin G4-related lymphoplasmacytic sclerosing cholangitis that mimics infiltrating hilar cholangiocarcinoma: part of a spectrum of autoimmune pancreatitis? Gastrointest Endosc. 2005;62:152–157.PubMedCrossRefGoogle Scholar
  15. 15.
    Kamisawa T, Funata N, Hayashi Y, et al. A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol. 2003;38:982–984.PubMedCrossRefGoogle Scholar
  16. 16.
    Matsuda M, Hamano H, Yoshida T, et al. Seronegative Sjogren syndrome with asymptomatic autoimmune sclerosing pancreatitis. Clin Rheumatol. 2007;26:117–119.PubMedCrossRefGoogle Scholar
  17. 17.
    Ravi K, Chari ST, Vege SS, Sandborn WJ, Smyrk TC, Loftus EV Jr. Inflammatory bowel disease in the setting of autoimmune pancreatitis. Inflamm Bowel Dis. 2009;15:1326–1330.PubMedCrossRefGoogle Scholar
  18. 18.
    Fukukura Y, Fujiyoshi F, Nakamura F, Hamada H, Nakajo M. Autoimmune pancreatitis associated with idiopathic retroperitoneal fibrosis. AJR Am J Roentgenol. 2003;181:993–995.PubMedGoogle Scholar
  19. 19.
    Tsushima K, Tanabe T, Yamamoto H, et al. Pulmonary involvement of autoimmune pancreatitis. Eur J Clin Invest. 2009;39:714–722.PubMedCrossRefGoogle Scholar
  20. 20.
    Komatsu K, Hamano H, Ochi Y, et al. High prevalence of hypothyroidism in patients with autoimmune pancreatitis. Dig Dis Sci. 2005;50:1052–1057.PubMedCrossRefGoogle Scholar
  21. 21.
    Ito H, Kaizaki Y, Noda Y, Fujii S, Yamamoto S. IgG4-related inflammatory abdominal aortic aneurysm associated with autoimmune pancreatitis. Pathol Int. 2008;58:421–426.PubMedCrossRefGoogle Scholar
  22. 22.
    Watson SJ, Jenkins DA, Bellamy CO. Nephropathy in IgG4-related systemic disease. Am J Surg Pathol. 2006;30:1472–1477.PubMedCrossRefGoogle Scholar
  23. 23.
    Jessurun J, Bolio-Solis A, Manivel JC. Diffuse lymphoplasmacytic acalculous cholecystitis: a distinctive form of chronic cholecystitis associated with primary sclerosing cholangitis. Hum Pathol. 1998;29:512–517.PubMedCrossRefGoogle Scholar
  24. 24.
    Abraham SC, Cruz-Correa M, Argani P, Furth EE, Hruban RH, Boitnott JK. Lymphoplasmacytic chronic cholecystitis and biliary tract disease in patients with lymphoplasmacytic sclerosing pancreatitis. Am J Surg Pathol. 2003;27:441–451.PubMedCrossRefGoogle Scholar
  25. 25.
    Kamisawa T, Tu Y, Nakajima H, et al. Sclerosing cholecystitis associated with autoimmune pancreatitis. World J Gastroenterol. 2006;12:3736–3739.PubMedGoogle Scholar
  26. 26.
    Wang WL, Farris AB, Lauwers GY, Deshpande V. Autoimmune pancreatitis-related cholecystitis: a morphologically and immunologically distinctive form of lymphoplasmacytic sclerosing cholecystitis. Histopathology. 2009;54:829–836.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Michael D. Leise
    • 1
  • Thomas C. Smyrk
    • 2
  • Naoki Takahashi
    • 3
  • Seth R. Sweetser
    • 1
  • Santhi S. Vege
    • 1
  • Suresh T. Chari
    • 1
  1. 1.Division of Gastroenterology and HepatologyMayo Clinic College of MedicineRochesterUSA
  2. 2.Department of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterUSA
  3. 3.Department of RadiologyMayo Clinic College of MedicineRochesterUSA

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