Guidance for diagnosing autoimmune pancreatitis with biopsy tissues

  • Kenji Notohara
    Department of Anatomic Pathology Kurashiki Central Hospital Okayama Japan
  • Terumi Kamisawa
    Tokyo Metropolitan Komagome Hospital Tokyo Japan
  • Noriyoshi Fukushima
    Department of Pathology Jichi Medical University Tochigi Japan
  • Toru Furukawa
    Department of Histopathology Tohoku University Graduate School of Medicine Miyagi Japan
  • Takuma Tajiri
    Department of Diagnostic Pathology Tokai University Hachioji Hospital Tokyo Japan
  • Hiroshi Yamaguchi
    Department of Pathology Saitama Medical University Saitama Japan
  • Shinichi Aishima
    Department of Pathology and Microbiology, Faculty of Medicine Saga University Saga Japan
  • Yuki Fukumura
    Department of Human Pathology Juntendo University School of Medicine Tokyo Japan
  • Kenichi Hirabayashi
    Department of Pathology Tokai University School of Medicine Tokyo Japan
  • Eisuke Iwasaki
    Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine Tokyo Japan
  • Atsushi Kanno
    Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
  • Satomi Kasashima
    Department of Clinical Laboratory Science Kanazawa University Ishikawa Japan
  • Atsuhiro Kawashima
    Department of Diagnostic Pathology National Hospital Organization Kanazawa Medical Center Ishikawa Japan
  • Motohiro Kojima
    Division of Pathology, Research Center for Innovative Oncology National Cancer Center Chiba Japan
  • Kensuke Kubota
    Depatment of Endoscopy Yokohama City University Hospital Kanagawa Japan
  • Yasuhiro Kuraishi
    Department of Gastroenterology Shinshu University School of Medicine Nagano Japan
  • Tomoko Mitsuhashi
    Department of Surgical Pathology Hokkaido University Hospital Hokkaido Japan
  • Yoshiki Naito
    Department of Diagnostic Pathology Kurume University Hospital Fukuoka Japan
  • Itaru Naitoh
    Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Aichi Japan
  • Hiroshi Nakase
    Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Hokkaido Japan
  • Takayoshi Nishino
    Department of Gastroenterology Tokyo Women's Medical University, Yachiyo Medical Center Chiba Japan
  • Nobuyuki Ohike
    Department of Pathology Showa University Fujigaoka Hospital Kanagawa Japan
  • Junichi Sakagami
    Department of Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto Japan
  • Kyoko Shimizu
    Department of Gastroenterology Tokyo Women's Medical University Tokyo Japan
  • Masahiro Shiokawa
    Department of Gastroenterology Kyoto University Hospital Kyoto Japan
  • Takeshi Uehara
    Department of Laboratory Medicine Shinshu University School of Medicine Nagano Japan
  • Tsukasa Ikeura
    Department of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
  • Shigeyuki Kawa
    Department of Internal Medicine Matsumoto Dental University Nagano Japan
  • Kazuichi Okazaki
    Kansai Medical University Kouri Hospital Osaka Japan

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<jats:p>The biopsy‐based diagnosis of autoimmune pancreatitis (AIP) is difficult but is becoming imperative for pathologists due to the increased amount of endoscopic ultrasound‐guided biopsy tissue. To cope with this challenge, we propose guidance for the biopsy diagnosis of type 1 AIP. This guidance is for pathologists and comprises three main parts. The first part includes basic issues on tissue acquisition, staining, and final diagnosis, and is intended for gastroenterologists as well. The second part is a practical guide for diagnosing type 1 AIP based on the AIP clinical diagnostic criteria 2018. Inconsistent histological findings, tips for evaluating IgG4 immunostaining and key histological features including the ductal lesion and others are explained. Storiform fibrosis and obliterative phlebitis are diagnostic hallmarks but are sometimes equivocal. Storiform fibrosis is defined as spindle‐shaped cells, inflammatory cells and fine collagen fibers forming a flowing arrangement. Obliterative phlebitis is defined as fibrous venous obliteration with inflammatory cells. Examples of each are provided. The third part describes the differentiation of AIP from pancreatic ductal adenocarcinoma (PDAC), focusing on histological features of acinar‐ductal metaplasia in AIP, which is an important mimicker of PDAC. This guidance will help standardize pathology reports of pancreatic biopsies for diagnosing type 1 AIP.</jats:p>

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