Involvement of the biliary system in autoimmune pancreatitis: a follow-up study Kenji Hirano, Yasushi Shiratori, Yutaka Komatsu, Natsuyo Yamamoto, Naoki.

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Involvement of the biliary system in autoimmune pancreatitis: a follow-up study Kenji Hirano, Yasushi Shiratori, Yutaka Komatsu, Natsuyo Yamamoto, Naoki Sasahira, Nobuo Toda, Hiroyuki Isayama, Minoru Tada, Takeshi Tsujino, Ryo Nakata, Tateo Kawase, Tetsuo Katamoto, Takao Kawabe, Masao Omata Clinical Gastroenterology and Hepatology Volume 1, Issue 6, Pages 453-464 (November 2003) DOI: 10.1016/S1542-3565(03)00221-0

Figure 1 Images of the main pancreatic duct and biliary tract system in patients with autoimmune pancreatitis (case 4). (A) Irregular narrowing of main pancreatic duct was observed on ERCP. (B) At the time of autoimmune pancreatitis diagnosis, abnormalities of extrapancreatic bile duct were not detected. The narrowing of intrapancreatic common bile duct was observed. Although the middle segment of the common bile duct appears normal under cholangiography, IDUS showed wall thickening of the bile duct. (C) Four months later, multiple stricture of the intrahepatic bile duct were identified. Clinical Gastroenterology and Hepatology 2003 1, 453-464DOI: (10.1016/S1542-3565(03)00221-0)

Figure 2 Imaging and histology of the patients presenting low-density area in the hepatic duct on CT (case 1). (A) CT scan showed swelling of the pancreatic head, a capsule-like rim (arrowheads), and a concentrated soft tissue mass around the abdominal aorta suggestive of retroperitoneal fibrosis. (Inset) Histologic examination of the pancreas showed lymphoplasmacyte infiltration with severe fibrosis and acinar cell depletion. H&E, original magnification 100×. (B) PTC showed multiple strictures of the hilar and intrahepatic bile ducts. IDUS performed during PTC showed marked thickening of the hilar duct wall (arrowheads). (C) CT scan showed a low-density area in the right hepatic duct (arrowheads). (Inset) Histologic examination of the liver showed lymphoplasmacytes infiltration with mild fibrosis in the portal area. H&E, original magnification 100×. Histologic examination of the tumor-like lesion around the bile duct on US, which coincided with the low-density area on CT, showed fibrotic tissue with mild inflammatory cell infiltration. H&E, original magnification 100×. Clinical Gastroenterology and Hepatology 2003 1, 453-464DOI: (10.1016/S1542-3565(03)00221-0)

Figure 3 Kaplan-Meier graph showing incidence rate of extrapancreatic bile duct changes. Clinical Gastroenterology and Hepatology 2003 1, 453-464DOI: (10.1016/S1542-3565(03)00221-0)

Figure 4 (Case 2) (original magnification 400×). Immunohistochemical study showed that the lymphocytes consisted mainly of UCHL-1+ T cells predominantly of CD8-positivity as opposed to CD4-positivity. L-26+ B cells were few in number. Clinical Gastroenterology and Hepatology 2003 1, 453-464DOI: (10.1016/S1542-3565(03)00221-0)

Figure 5 (Case 5) (original magnification 400×). Immunohistochemical study showed most of the lymphocytes in the portal area consisted mainly of UCHL-1+ T cells predominantly of CD8-positivity as opposed to CD4-positivity. L-26+ B cells were few in number. Clinical Gastroenterology and Hepatology 2003 1, 453-464DOI: (10.1016/S1542-3565(03)00221-0)

Figure 6 Improvement of the pancreatic swelling and bile duct stricture after prednisolone treatment (case 1). (A) Compared with Figure 2A, swelling of the pancreatic head and fibrosis around the abdominal aorta improved after prednisolone treatment. Compared with Figure 2B, PTC showed an improvement of bile duct changes after prednisolone treatment. IDUS performed during PTC showed an improvement after prednisolone treatment. The thickness of the low echoic layer changed from 5 to 3 mm (arrowheads). (C) Compared with Figure 2C, the low-density area in the right hepatic duct disappeared after prednisolone treatment. Clinical Gastroenterology and Hepatology 2003 1, 453-464DOI: (10.1016/S1542-3565(03)00221-0)