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



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.


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.


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.


Autoimmune pancreatitis IgG4-associated systemic disease IgG4 Gallbladder 


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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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