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#redirect [[Pancreas#Chronic_pancreatitis]]
'''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 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]]
Michael
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