Clinicopathological differentiation between sclerosing cholangitis with autoimmune pancreatitis and primary sclerosing cholangitis
- 25 July 2007
- journal article
- Published by Springer Science and Business Media LLC in The Esophagus
- Vol. 42 (7), 550-559
- https://doi.org/10.1007/s00535-007-2038-8
Abstract
The present study was undertaken to identify the clinicopathological differences between sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and primary sclerosing cholangitis (PSC). We retrospectively compared the clinical, cholangiographic, and liver biopsy findings between 24 cases of PSC and 24 cases of SC-AIP. Patient age at the time of diagnosis was significantly lower in the PSC group than in the SC-AIP group. The peripheral blood eosinophil count was significantly higher in the PSC group than in the SC-AIP group, but the serum IgG4 level was significantly higher in the SC-AIP group. Cholangiography revealed band-like strictures, beaded appearance, and pruned-tree appearance significantly more frequently in PSC, whereas segmental strictures and strictures of the distal third of the common bile duct were significantly more common in SC-AIP. Liver biopsy revealed fibrous obliterative cholangitis only in the PSC specimens. No advanced fibrous change corresponding to Ludwig's stages 3 and 4 was observed in any of the SC-AIP specimens. IgG4-positive plasma cell infiltration of the liver was significantly more severe in SC-AIP than in PSC. Subsequent cholangiography showed no improvement in any of the PSC cases, but all SC-AIP patients responded to steroid therapy, and improvement in the strictures was observed cholangiographically. Based on the differences between the patients' ages and blood chemistry, cholangiographic, and liver biopsy findings, SC-AIP should be differentiated from PSC.Keywords
This publication has 27 references indexed in Scilit:
- Clinical diagnostic criteria of autoimmune pancreatitis: revised proposalThe Esophagus, 2006
- IgG4-related Sclerosing Cholangitis With and Without Hepatic Inflammatory Pseudotumor, and Sclerosing Pancreatitis-associated Sclerosing CholangitisThe American Journal of Surgical Pathology, 2004
- Analysis of 388 cases of primary sclerosing cholangitis in JapanPresence of a subgroup without pancreatic involvement in older patientsHepatology Research, 2004
- Concomitant colitis associated with primary sclerosing cholangitisThe Esophagus, 2003
- ERCP features in 27 patients with autoimmune pancreatitisGastrointestinal Endoscopy, 2002
- High Serum IgG4 Concentrations in Patients with Sclerosing PancreatitisNew England Journal of Medicine, 2001
- Primary sclerosing cholangitis and ulcerative colitis: Evidence for increased neoplastic potentialHepatology, 1995
- Chronic pancreatitis caused by an autoimmune abnormalityDigestive Diseases and Sciences, 1995
- Primary sclerosing cholangitis: value of cholangiography in determining the prognosis.American Journal of Roentgenology, 1991
- Manifestations of nonsuppurative cholangitis in chronic hepatobiliary diseases: morphologic spectrum, clinical correlations and terminologyLiver International, 1984