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Recent Advances in Autoimmune Pancreatitis

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

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

3 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  , 39-51DOI: ( /j.gastro ) Copyright © 2015 AGA Institute Terms and Conditions

4 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  , 39-51DOI: ( /j.gastro ) Copyright © 2015 AGA Institute Terms and Conditions

5 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  , 39-51DOI: ( /j.gastro ) Copyright © 2015 AGA Institute Terms and Conditions

6 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  , 39-51DOI: ( /j.gastro ) Copyright © 2015 AGA Institute Terms and Conditions

7 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  , 39-51DOI: ( /j.gastro ) Copyright © 2015 AGA Institute Terms and Conditions


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