November 12, 2014
Notes: Mir, Mohd Altaf
Bali, Biant Singh
Mir, Riyaz Ahmad
Ulus Travma Acil Cerrahi Derg. 2013 Mar;19(2):103-8. doi: 10.5505/tjtes.2013.12080.
Author Address: Department of Surgery, Government Medical College Srinagar, India. email@example.com
Reference Type: Journal Article
Record Number: 5259Author: Miyabe, K., Notohara, K., Nakazawa, T., Hayashi, K., Naitoh, I., Okumura, F., Shimizu, S., Yoshida, M., Yamashita, H., Takahashi, S., Ohara, H. and Joh, T.
Title: Histological evaluation of obliterative phlebitis for the diagnosis of autoimmune pancreatitis
Journal: J Gastroenterol
Short Title: Histological evaluation of obliterative phlebitis for the diagnosis of autoimmune pancreatitis
Alternate Journal: Journal of gastroenterology
ISSN: 1435-5922 (Electronic)
Accession Number: 23645070
Abstract: BACKGROUND: Obliterative phlebitis is a useful pathological finding for the diagnosis of lymphoplasmacytic sclerosing pancreatitis (LPSP), or type 1 autoimmune pancreatitis. The present study evaluated histological findings of obliterative phlebitis, including the significance of adding Elastica van Gieson stain (EVG) in comparison with other pancreatic conditions. METHODS: Specimens of LPSP (n = 18), chronic pancreatitis (CP; n = 24), and pancreatic ductal adenocarcinoma (PDA; n = 45) were enrolled. Obliterative venous lesions (OVLs), defined as the presence of inflammatory cells and/or fibrosis inside the tunica adventitia, were counted and compared between hematoxylin and eosin stain (H&E) and EVG. OVLs were classified into three types: OVL-1, lymphoplasmacytic infiltration and fibrosis against a loose textured background; OVL-2, dense fibrosis with minimal or no lymphoplasmacytic infiltration; and OVL-3, densely packed lymphoplasmacytic infiltration without fibrosis. OVL type and OVL size were compared between disease groups. RESULTS: OVL counts in LPSP, CP, and PDA were significantly higher with EVG than with H&E (p < 0.001). OVL-1 was most common in LPSP (H&E 92.4 %, EVG 79.8 %), and was identified in almost all cases of LPSP, but was less common in CP and PDA. Maximum diameter and OVL count in 1 cm(2) of OVL-1 were high for LPSP. Maximum diameter of OVL-1 >/=150 mum was observed in 17 LPSP, 0 CP, and 1 PDA cases (sensitivity 94.4 %, specificity 98.6 %). CONCLUSIONS: Additional EVG is useful for excluding conditions mimicking OVL-1 or detecting OVL in small specimens. The presence of OVL-1 with diameter >/=150 mum is highly diagnostic for LPSP.