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# | '''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-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> | |||
*p53. | |||
*Mesothelin. | |||
==See also== | |||
*[[Acute pancreatitis]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Gastrointestinal pathology]] | |||