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Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens

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Abstract

Background and Aims

Autoimmune pancreatitis seems to be a disease with a heterogeneous appearance. Our intention was to establish key diagnostic criteria, define grades of severity and activity, identify features of potential subtypes and evaluate the diagnostic relevance of biopsy specimens.

Methods

Histopathological criteria and clinical features were recorded in pancreatic resection specimens from 53 patients who were found to have chronic pancreatitis lacking pseudocysts, calculi, irregular duct dilatations, pancreas divisum and/or duodenal wall inflammation. The severity of the chronic inflammation was graded, and the activity of the acute inflammatory component and the granulocytic epithelial lesion (GEL) were determined. Additionally, pancreatic biopsy specimens from 9 patients with suspected AIP were assessed.

Results

Periductal lymphoplasmacytic infiltration was identified in all cases, followed in order of frequency by periductal fibrosis and venulitis. These changes were absent in 147 pancreatic specimens that showed chronic pancreatitis associated with pseudocysts, calculi, pancreas divisum and/or duodenal wall inflammation. In 90% of the cases, these chronic changes were graded as 3 or 4. In 81%, the inflammatory process resided in the head of the pancreas and involved the common bile duct. GELs were present in 42% of the patients, who had a mean age of 40.5 years, an almost equal male–female ratio and a high coincidence of ulcerative colitis or Crohn’s disease. Patients without GELs were older (mean age 64 years), showed a male preponderance, commonly had Sjögren’s syndrome and often developed recurrent bile-duct stenosis. Diagnostically relevant lesions were present in two of five wedge biopsy specimens and three of four fine-needle specimens.

Conclusions

Periductal lymphoplasmacytic infiltration and fibrosis, preferential occurrence in the pancreatic head and venulitis characterize autoimmune pancreatitis. GELs predominantly occur in a subset of patients who are younger, more commonly have ulcerative colitis and Crohn’s disease and seem to have fewer recurrences than patients without GELs. Pancreatic biopsy material proved to be a very helpful adjunct for establishing the diagnosis.

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Acknowledgements

Sincere thanks are due to the many pathologists who sent in cases for consultation. Specifically, we would like to thank Drs. Anita Goossens and Franz Borchert. We are grateful to M. Pacena and A. Paulus for their excellent technical assistance and K. Dege for editing the manuscript.

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Authors and Affiliations

  1. Department of Pathology, University of Verona, Verona, Italy

    Giuseppe Zamboni & Paola Capelli

  2. Department of Pathology, University of Kiel, Michaelisstrasse 11, 24105 , Kiel, Germany

    Jutta Lüttges & Günter Klöppel

  3. Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy

    Luca Frulloni, Giorgio Cavallini & Paolo Pederzoli

  4. Department of Surgery, University of Kiel, Kiel, Germany

    Alexander Leins

  5. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Daniel Longnecker

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  1. Giuseppe Zamboni
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  2. Jutta Lüttges
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Correspondence to Günter Klöppel.

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Zamboni, G., Lüttges, J., Capelli, P. et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch 445, 552–563 (2004). https://doi.org/10.1007/s00428-004-1140-z

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  • DOI: https://doi.org/10.1007/s00428-004-1140-z

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