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Ultra thin needle histology may have impact in diagnosing chronic
pancreatitis.Scand
J Gastroenterol. 2007 Apr;42(4):508-12.
OBJECTIVE:
Diagnosis of chronic pancreatitis is usually based on symptoms, ductal
or parenchymal changes in imaging studies and function tests, but
seldom on histology. Because the diagnosis of mild chronic
pancreatitis is especially difficult, better tools to distinguish
between chronic pancreatitis and normal pancreas are needed. Nowadays,
cutting needles as thin as the widely used puncture needles are
available. Using resected specimens, our aim was to evaluate whether
these ultra-thin needles can take samples for histology that would
allow verification of the diagnosis of chronic pancreatitis, with
reference to a pancreatic wedge biopsy as the "gold standard".
MATERIAL AND METHODS: Fifty patients underwent pancreatic resection
for various reasons. Two 20 G needle biopsies (outer diameter 0.8 mm,
study biopsies) and a 5 x 5-mm wedge biopsy (reference biopsies) were
taken from the same site of the specimen, avoiding possible neoplastic
areas in the specimen. The samples were analyzed for the presence
inflammation and fibrosis, both graded 0-3, as well as for any
neoplastic changes without knowledge of the medical history, operative
findings or final histology. RESULTS: The reference biopsy showed
normal tissue in 19 (38%) patients, chronic pancreatitis in 29 (58%)
and only mild fibrosis (Grade 1) in 2 (4%) patients. In one patient
the needle biopsy was insufficient for analysis. There was agreement
between ultra-thin needle histology and the control specimen in 45/49
(92%) patients (correlation coefficient 0.9). Two biopsies of chronic
pancreatitis and one mild fibrosis were misclassified as normal
tissue, while one chronic pancreatitis biopsy was misclassified as an
adenocarcinoma. The sensitivity of needle biopsy for chronic
pancreatitis was 89%, specificity 100% and accuracy 94%. CONCLUSIONS:
Ultra-thin needle histology correlates well with the pancreatic wedge
biopsy. Thus, these encouraging results warrant further clinical
studies of different grades and types of chronic pancreatitis.
Histopathological
features of diagnostic and clinical relevance in autoimmune
pancreatitis: a study on 53 resection specimens and 9 biopsy
specimens.Virchows
Arch. 2004 Dec;445(6):552-63.
BACKGROUND AND
AIMS: Autoimmune pancreatitis seems to be a disease with a
heterogeneous appearance. Our intention was to establish key
diagnostic criteria, define grades of severity and activity, identify
features of potential subtypes and evaluate the diagnostic relevance
of biopsy specimens. METHODS: Histopathological criteria and clinical
features were recorded in pancreatic resection specimens from 53
patients who were found to have chronic pancreatitis lacking
pseudocysts, calculi, irregular duct dilatations, pancreas divisum
and/or duodenal wall inflammation. The severity of the chronic
inflammation was graded, and the activity of the acute inflammatory
component and the granulocytic epithelial lesion (GEL) were
determined. Additionally, pancreatic biopsy specimens from 9 patients
with suspected AIP were assessed. RESULTS: Periductal
lymphoplasmacytic infiltration was identified in all cases, followed
in order of frequency by periductal fibrosis and venulitis. These
changes were absent in 147 pancreatic specimens that showed chronic
pancreatitis associated with pseudocysts, calculi, pancreas divisum
and/or duodenal wall inflammation. In 90% of the cases, these chronic
changes were graded as 3 or 4. In 81%, the inflammatory process
resided in the head of the pancreas and involved the common bile duct.
GELs were present in 42% of the patients, who had a mean age of 40.5
years, an almost equal male-female ratio and a high coincidence of
ulcerative colitis or Crohn's disease. Patients without GELs were
older (mean age 64 years), showed a male preponderance, commonly had
Sjogren's syndrome and often developed recurrent bile-duct stenosis.
Diagnostically relevant lesions were present in two of five wedge
biopsy specimens and three of four fine-needle specimens. CONCLUSIONS:
Periductal lymphoplasmacytic infiltration and fibrosis, preferential
occurrence in the pancreatic head and venulitis characterize
autoimmune pancreatitis. GELs predominantly occur in a subset of
patients who are younger, more commonly have ulcerative colitis and
Crohn's disease and seem to have fewer recurrences than patients
without GELs. Pancreatic biopsy material proved to be a very helpful
adjunct for establishing the diagnosis.
Clinical study of
chronic pancreatitis with focal irregular narrowing of the main
pancreatic duct and mass formation: comparison with chronic
pancreatitis showing diffuse irregular narrowing of the main
pancreatic duct.Pancreas.
2002 Oct;25(3):283-9.
INTRODUCTION:
Main pancreatic duct (MPD)-narrowed chronic pancreatitis (CP) may be
an autoimmune abnormality. It also has been called autoimmune
pancreatitis and sclerosing pancreatitis. It is unclear whether cases
with focal pancreatographic changes are part of the same clinical
entity as cases with diffuse MPD changes. AIM AND METHODOLOGY: We
reviewed seven cases of chronic pancreatitis (CP) with focal narrowing
of the main pancreatic duct (MPD), evidenced by endoscopic retrograde
cholangiopancreatography (ERCP), and swelling of one or two segments
of the pancreas, evidenced by ultrasonography (US) /computed
tomography (CT), and indicated the clinicopathologic features of
focal-type MPD-narrowed CP. RESULTS: The patient group comprised six
men and one woman, and their age range was 28-75 years, with a mean of
63.7 years. Affected sites were in the head in two patients, the body
in one patient, the tail in one patient, and the body and tail in
three patients; ERP showed narrowing in six patients and obstruction
in one. Stricture of the lower portion of the common bile duct (CBD)
that caused obstructive jaundice was shown by ERC in two cases in
which the pancreas head was affected. In all six patients, a dynamic
study by CT or MRI homogeneously showed delayed enhancement of
involved segments of the pancreas. Serum levels of pancreatic enzyme
were elevated in five patients, but only one subject had pancreatitis-like
epigastric pain. Serological evidence suggestive of autoimmune
abnormality was detected in only three patients with
hypergammaglobulinemia (> or =2.0 g/dL) or positive titers of
antinuclear antibody (ANA; > or =80). Histological assessment was
available for five patients, who characteristically had dense
lymphocytic or plasmocytic infiltration with severe fibrosis that
caused luminal narrowing. The clinical, serologic, and histologic
findings as described above were comparable to those for 12 CP
patients with diffuse narrowing of the MPD, diagnosed during the same
period. Surgical resection was performed in 5 patients, in 2 of whom a
similar inflammatory process recurred in the remnant head of the
pancreas, whereas pancreatitis no longer developed in the other 3
patients. One patient was initially treated with steroids, with
clinical remission, although there was neither hypergammaglobulinemia
nor positive ANA. CONCLUSION: These results indicate that CP with
focal narrowing of the MPD is part of the same clinical spectrum as CP
with diffuse narrowing of the MPD, and whether the distribution is
diffuse or focal seems to be related to the stage or the extent of the
disease. It is therefore important to recognize the possible existence
of this focal variant to avoid unnecessary surgery.
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