Michael: /* IHC */

2016-05-21T04:11:33Z

IHC

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	==IHC==		==IHC==
	*IgG4 +ve plasma cells -- [[IgG4 sclerosing disease]].		*IgG4 +ve plasma cells - [[IgG4-related systemic diseases\|IgG4 sclerosing disease]].

	Positive in pancreatic carcinoma:<ref name=pmid15725808>{{Cite journal \| last1 = Hornick \| first1 = JL. \| last2 = Lauwers \| first2 = GY. \| last3 = Odze \| first3 = RD. \| title = Immunohistochemistry can help distinguish metastatic pancreatic adenocarcinomas from bile duct adenomas and hamartomas of the liver. \| journal = Am J Surg Pathol \| volume = 29 \| issue = 3 \| pages = 381-9 \| month = Mar \| year = 2005 \| doi = \| PMID = 15725808 }}</ref>		Positive in pancreatic carcinoma:<ref name=pmid15725808>{{Cite journal \| last1 = Hornick \| first1 = JL. \| last2 = Lauwers \| first2 = GY. \| last3 = Odze \| first3 = RD. \| title = Immunohistochemistry can help distinguish metastatic pancreatic adenocarcinomas from bile duct adenomas and hamartomas of the liver. \| journal = Am J Surg Pathol \| volume = 29 \| issue = 3 \| pages = 381-9 \| month = Mar \| year = 2005 \| doi = \| PMID = 15725808 }}</ref>

Michael at 04:11, 21 May 2016

2016-05-21T04:11:02Z

← Older revision		Revision as of 04:11, 21 May 2016
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	#~~redirect~~ [[~~Pancreas~~#~~Chronic_pancreatitis~~]]		'''Chronic pancreatitis''' is a relatively common pathology of the [[pancreas]] that can be confused for a [[pancreatic cancer]].

			==General==
			*May be confused with [[pancreatic ductal adenocarcinoma\|ductal adenocarcinoma]] radiologically... and pathologically.
			*Often due to [[ethanol abuse]].

			Complications:<ref name=Ref_PCPBoD8_469>{{Ref PCPBoD8\|469}}</ref>
			*Malabsorption.
			*[[Diabetes mellitus]].
			*Pseudocysts.

			===Autoimmune pancreatitis===
			Histologic subtypes of autoimmune pancreatitis:<ref>URL: [http://path.upmc.edu/cases/case651/dx.html http://path.upmc.edu/cases/case651/dx.html]. Accessed on: 28 January 2012.</ref>
			#Lymphoplasmacytic sclerosing pancreatitis (LPSP).
			#*Typically IgG4 positive -- one of the ''[[IgG4-related systemic disease]]s''.
			#**IgG4 negative cases reported.<ref name=pmid20824290/><ref name=pmid22466829>{{Cite journal \| last1 = Ikeura \| first1 = T. \| last2 = Takaoka \| first2 = M. \| last3 = Uchida \| first3 = K. \| last4 = Shimatani \| first4 = M. \| last5 = Miyoshi \| first5 = H. \| last6 = Kusuda \| first6 = T. \| last7 = Kurishima \| first7 = A. \| last8 = Fukui \| first8 = Y. \| last9 = Sumimoto \| first9 = K. \| title = Autoimmune pancreatitis with histologically proven lymphoplasmacytic sclerosing pancreatitis with granulocytic epithelial lesions. \| journal = Intern Med \| volume = 51 \| issue = 7 \| pages = 733-7 \| month = \| year = 2012 \| doi = \| PMID = 22466829 }}</ref>
			#*Approximately 80% of cases.<ref name=pmid20824290>{{Cite journal \| last1 = Kamisawa \| first1 = T. \| last2 = Takuma \| first2 = K. \| last3 = Tabata \| first3 = T. \| last4 = Inaba \| first4 = Y. \| last5 = Egawa \| first5 = N. \| last6 = Tsuruta \| first6 = K. \| last7 = Hishima \| first7 = T. \| last8 = Sasaki \| first8 = T. \| last9 = Itoi \| first9 = T. \| title = Serum IgG4-negative autoimmune pancreatitis. \| journal = J Gastroenterol \| volume = 46 \| issue = 1 \| pages = 108-16 \| month = Jan \| year = 2011 \| doi = 10.1007/s00535-010-0317-2 \| PMID = 20824290 }}</ref>
			#Idiopathic duct-centric chronic pancreatitis (IDCP).
			#*Typically IgG4 negative.
			#*Approximately 20% of cases.

			====Lymphoplasmacytic sclerosing pancreatitis====
			General:
			*Serum IgG4 +ve.<ref name=pmid17533077>{{Cite journal \| last1 = Krasinskas \| first1 = AM. \| last2 = Raina \| first2 = A. \| last3 = Khalid \| first3 = A. \| last4 = Tublin \| first4 = M. \| last5 = Yadav \| first5 = D. \| title = Autoimmune pancreatitis. \| journal = Gastroenterol Clin North Am \| volume = 36 \| issue = 2 \| pages = 239-57, vii \| month = Jun \| year = 2007 \| doi = 10.1016/j.gtc.2007.03.015 \| PMID = 17533077 }}</ref>
			Microscopic:
			*Lymphoplasmacytic infiltrate.
			IHC:
			*Plasma cells IgG4 +ve.

			==Radiology==
			Plain film findings:
			*Calcifications.

			==Microscopic==
			Features of chronic pancreatitis:<ref name=pmid16273946>{{Cite journal \| last1 = Adsay \| first1 = NV. \| last2 = Bandyopadhyay \| first2 = S. \| last3 = Basturk \| first3 = O. \| last4 = Othman \| first4 = M. \| last5 = Cheng \| first5 = JD. \| last6 = Klöppel \| first6 = G. \| last7 = Klimstra \| first7 = DS. \| title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? \| journal = Semin Diagn Pathol \| volume = 21 \| issue = 4 \| pages = 268-76 \| month = Nov \| year = 2004 \| doi = \| PMID = 16273946 }}</ref>
			*Preservation of lobular architecture - evenly spaced ductal units.
			*Uniformly sized ductal elements.
			*Smooth ductal contours.
			*Ducts surrounded by acini or islets.
			**Islets usu. preserved better than acini.<ref name=Ref_Klatt225>{{Ref Klatt\|225}}</ref>
			*Intraluminal mucoprotein plugs.

			Images:
			*[http://path.upmc.edu/cases/case651.html Autoimmune pancreatitis / IgG4 sclerosing disease - several images (upmc.edu)].

			===Adenocarcinoma versus pancreatitis===
			This contrasts with the features of adenocarcinoma:<ref name=pmid16273946>{{Cite journal \| last1 = Adsay \| first1 = NV. \| last2 = Bandyopadhyay \| first2 = S. \| last3 = Basturk \| first3 = O. \| last4 = Othman \| first4 = M. \| last5 = Cheng \| first5 = JD. \| last6 = Klöppel \| first6 = G. \| last7 = Klimstra \| first7 = DS. \| title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? \| journal = Semin Diagn Pathol \| volume = 21 \| issue = 4 \| pages = 268-76 \| month = Nov \| year = 2004 \| doi = \| PMID = 16273946 }}</ref>
			*Ductal architecture:
			**Random distribution of ductal structures.
			**Irregular ductal contours.
			**"Naked ducts in fat"; ducts without surrounding pancreatic elements or fibrous tissue.
			**Ducts adjacent to arterioles.
			*Nuclear atypia:
			**Enlargement (>3 times the size of a lymphocyte).
			**Pleomorphism.
			**Distinct [[nucleoli]].
			**Hyperchromatic raisinoid nucleoli.
			*Generally assoc. with malignancy:
			**[[perineural invasion\|Perineural]] and [[vascular invasion]] (rare).
			**Mitosis.
			**Necrotic cellular debris (intraluminal).

			Notes:
			*Memory device: ''give 'em a '''fair''' chance'' at a benign diagnosis. Features suggestive of malignant:
			**Fat, adjacent to.
			**Arteriole, adjacent to.
			**Irregular ducts.
			**Random distribution of ducts/non-lobular arrangement.

			==IHC==
			*IgG4 +ve plasma cells -- [[IgG4 sclerosing disease]].

			Positive in pancreatic carcinoma:<ref name=pmid15725808>{{Cite journal \| last1 = Hornick \| first1 = JL. \| last2 = Lauwers \| first2 = GY. \| last3 = Odze \| first3 = RD. \| title = Immunohistochemistry can help distinguish metastatic pancreatic adenocarcinomas from bile duct adenomas and hamartomas of the liver. \| journal = Am J Surg Pathol \| volume = 29 \| issue = 3 \| pages = 381-9 \| month = Mar \| year = 2005 \| doi = \| PMID = 15725808 }}</ref>
			*p53.
			*Mesothelin.

			==See also==
			*[[Acute pancreatitis]].

			==References==
			{{Reflist\|1}}

	[[Category:Diagnosis]]		[[Category:Diagnosis]]
			[[Category:Gastrointestinal pathology]]

Michael: redirect

2011-10-18T03:46:29Z

redirect

New page

#redirect [[Pancreas#Chronic_pancreatitis]]

[[Category:Diagnosis]]

Chronic pancreatitis - Revision history

Michael: /* IHC */

Michael at 04:11, 21 May 2016

Michael: redirect