Recent Advances in Autoimmune Pancreatitis Phil A. Hart, Yoh Zen, Suresh T. Chari  Gastroenterology  Volume 149, Issue 1, Pages 39-51 (July 2015) DOI: 10.1053/j.gastro.2015.03.010 Copyright © 2015 AGA Institute Terms and Conditions

Figure 1 The proposed immunologic interactions contributing to the various clinical manifestations in AIP. Gastroenterology 2015 149, 39-51DOI: (10.1053/j.gastro.2015.03.010) Copyright © 2015 AGA Institute Terms and Conditions

Figure 2 Representative histopathologic features in resected pancreatic specimens from patients with (A–C) AIP and (D) IDCP, including (A) lymphoplasmacytic inflammation, (B) storiform fibrosis (in a swirled pattern), (C) obliterative phlebitis (arrow, Elastica van Gieson stain), and (D) GEL (asterisk). Gastroenterology 2015 149, 39-51DOI: (10.1053/j.gastro.2015.03.010) Copyright © 2015 AGA Institute Terms and Conditions

Figure 3 Histological findings in patients with (A and B) AIP and (C and D) IDCP obtained from endoscopic ultrasonography–guided core biopsies show (A) a prominent fibroinflammatory process. (B) Immunostaining for IgG4 highlights infiltration of IgG4+ plasma cells (>10 cells in this field). (C) Neutrophils infiltrate the epithelial layer of the pancreatic duct, forming a small aggregate (arrow). This change is in keeping with a GEL. (D) Involved ductules are infiltrated by many neutrophils, another suggestive feature of IDCP. Gastroenterology 2015 149, 39-51DOI: (10.1053/j.gastro.2015.03.010) Copyright © 2015 AGA Institute Terms and Conditions

Figure 4 Computed tomographic imaging from 2 different patients with AIP shows the typical diffuse pancreatic enlargement as well as (A) the hypoattenuating rim seen in 30% of patients and (B) the characteristic parenchymal hypoattenuation, which is best seen during the portal phase. Gastroenterology 2015 149, 39-51DOI: (10.1053/j.gastro.2015.03.010) Copyright © 2015 AGA Institute Terms and Conditions

Figure 5 Pancreatic duct imaging features of AIP obtained at the time of endoscopic retrograde cholangiopancreatography in 2 patients. (A) A long stricture in the head of the pancreas without upstream ductal dilation. Additionally, side branches are seen arising from the strictured segment. (B) Multifocal strictures of the main pancreatic duct. Gastroenterology 2015 149, 39-51DOI: (10.1053/j.gastro.2015.03.010) Copyright © 2015 AGA Institute Terms and Conditions

Figure 6 A proposed treatment algorithm for management of disease relapses for patients with firmly established AIP (ie, malignancy has been excluded). Adapted from Hart et al with permission from the BMJ Publishing Group.51 Gastroenterology 2015 149, 39-51DOI: (10.1053/j.gastro.2015.03.010) Copyright © 2015 AGA Institute Terms and Conditions