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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 05/2013; 110(5):780-7.
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Yuri Fukui,
Kazushige Uchida, Kimi Sumimoto,
Takeo Kusuda,
Hideaki Miyoshi,
Masanori Koyabu,
Tsukasa Ikeura,
Yutaku Sakaguchi,
Masaaki Shimatani,
Toshiro Fukui,
Mitsunobu Matsushita,
Makoto Takaoka,
Akiyoshi Nishio,
Nobuaki Shikata,
Noriko Sakaida,
Yoshiko Uemura,
Sohei Satoi,
A-Hon Kwon,
Kazuichi Okazaki
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ABSTRACT: BACKGROUND: High serum immunoglobulin G4 (IgG4) levels and infiltration of IgG4-positive cells are characteristic of Type 1 autoimmune pancreatitis (AIP). We previously reported that increased regulatory T cells (Tregs) may regulate IgG4 production in AIP. Although an increased serum IgG4 concentration is observed in some patients with pancreatic ductal adenocarcinoma (PDA), clarification is still necessary. We have therefore studied the correlations between IgG4-positive cells and Tregs in patients with PDA. SUBJECTS AND METHODS: A total of 21 PDA and nine AIP patients were enrolled in our study. The numbers and ratios of Tregs, IgG4-positive, and IgG-positive cells immunohistochemically stained with anti-Foxp3, IgG4, and IgG antibodies, respectively, were counted in three areas of resected pancreata in PDA, peritumoral pancreatitis (PT), and obstructive pancreatitis (OP). RESULTS: In PDA, PT, OP area, the number of IgG4-Positive cells (5.183 ± 1.061, 2.250 ± 0.431, 4.033 ± 1.018, respectively; p < 0.05) and the ratio of IgG4/IgG (0.391 ± 0.045, 0.259 ± 0.054, 0.210 ± 0.048, respectively; p < 0.05) were significantly lower than those in AIP (21.667 ± 2.436 and 0.306 ± 0.052, respectively). The numbers of IgG4-positive cells did not differ significantly among the three areas of resected pancreata examined. However, the IgG4/IgG (0.391 ± 0.045) and Foxp3/monocyte (0.051 ± 0.008) ratios in PDA area were significantly (p < 0.05) higher than those in OP area (IgG4/IgG: 0.210 ± 0.048; oxp3/monocyte: 0.0332 ± 0.005), but not in PT area. Of the 21 cases of PDA, the ratio of IgG4/IgG was >40 % in nine (43 %), six (29 %) and three (14 %) cases in PDA, PT and OP area, respectively. Foxp3 and IgG4 were positively correlated in OP area, but not in PDA and PT area. CONCLUSIONS: Clinicians should be careful when basing a differential diagnosis of PDA and AIP on the numbers of IgG4-positive cells and the ratio of IgG4/IgG, especially when determined using a small biopsied sample.
Journal of Gastroenterology 10/2012; · 4.16 Impact Factor
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Kazushige Uchida,
Takeo Kusuda,
Masanori Koyabu,
Hideaki Miyoshi,
Norimasa Fukata, Kimi Sumimoto,
Yuri Fukui,
Yutaku Sakaguchi,
Tsukasa Ikeura,
Masaaki Shimatani,
Toshiro Fukui,
Mitsunobu Matsushita,
Makoto Takaoka,
Akiyoshi Nishio,
Kazuichi Okazaki
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ABSTRACT: Autoimmune pancreatitis (AIP) is a newly recognized pancreatic disorder. Recently, International Consensus Diagnostic Criteria for AIP (ICDC) was published. In this ICDC, AIP was classified into Type 1 and Type 2. Patients with Type 1 AIP have several immunologic and histologic abnormalities specific to the disease, including increased levels of serum IgG4 and storiform fibrosis with infiltration of lymphocytes and IgG4-positive plasmacytes in the involved organs. Among the involved organs showing extrapancreatic lesions, the bile duct is the most common, exhibiting sclerosing cholangitis (IgG4-SC). However, the role of IgG4 is unclear. Recently, it has been reported that regulatory T cells (Tregs) are involved in both the development of various autoimmune diseases and the shift of B cells toward IgG4, producing plasmacytes. Our study showed that Tregs were increased in the pancreas with Type 1 AIP and IgG4-SC compared with control. In the patients with Type 1 AIP and IgG4-SC, the numbers of infiltrated Tregs were significantly positively correlated with IgG4-positive plasma cells. In Type 1 AIP, inducible costimulatory molecule (ICOS)(+) and IL-10(+) Tregs significantly increased compared with control groups. Our data suggest that increased quantities of ICOS(+) Tregs may influence IgG4 production via IL-10 in Type 1 AIP.
International Journal of Rheumatology 01/2012; 2012:795026.
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Tsukasa Ikeura,
Makoto Takaoka,
Kazushige Uchida,
Masaaki Shimatani,
Hideaki Miyoshi,
Takeo Kusuda,
Akiko Kurishima,
Yuri Fukui, Kimi Sumimoto,
Sohei Satoi,
Chisato Ohe,
Yoshiko Uemura,
A-Hon Kwon,
Kazuichi Okazaki
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ABSTRACT: Recent histological and clinical studies have suggested the existence of 2 distinct types of autoimmune pancreatitis (AIP): type 1 AIP related to IgG4, exhibiting lymphoplasmacytic sclerosing pancreatitis (LPSP), and type 2 AIP related to granulocyte epithelial lesions (GELs), exhibiting idiopathic duct-centric chronic pancreatitis (IDCP). We herein present a case of type 1 AIP with histologically proven LPSP with GELs. This patient had neither serum IgG4 elevation nor MPD narrowing. In this case, the clinically and histologically atypical findings for type 1 AIP are intriguing.
Internal Medicine 01/2012; 51(7):733-7. · 0.94 Impact Factor
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ABSTRACT: Xanthogranulomatous inflammation (XGI) is histopathologically characterized by a marked proliferative fibrosis, parenchymal destruction, and infiltration of foamy histiocytes intermixed with other inflammatory cells. Herein, we report a case of a 73-year-old man without symptoms who was initially diagnosed with a pancreatic cystic tumor but later with XGI in the peripancreatic region. Although XGI has been reported to occur in various organs or tissues, such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, and soft tissues, XGI involving the pancreas or its surrounding tissues is extremely rare. When a pancreatic cystic lesion does not have typical clinicoradiological features of common pancreatic cystic neoplasms, this pathologic condition should be considered in the differential diagnosis.
Internal Medicine 01/2009; 48(21):1881-4. · 0.94 Impact Factor
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Inflammatory Bowel Diseases 06/2008; 14(5):728-30. · 4.86 Impact Factor
