自身免疫性胰腺炎3例临床病理分析并文献复习

Clinicopathological study of autoimmune pancreatitis: report of 3 cases and review of the literature

目的探讨自身免疫性胰腺炎(AIP)两个亚型临床病理特点及诊断和鉴别诊断要点。方法结合临床病史,对3例AIP标本进行病理形态学观察和免疫组织化学染色分析,并进行文献复习。结果 2例Ⅰ型AIP,组织学表现为胰管扩张,周围淋巴、浆细胞浸润,伴席纹状纤维化;免疫组化Ig G4>10/HPF,Ig G4/Ig G>40%。1例Ⅱ型AIP,组织学表现为胰管扩张,周围淋巴、浆细胞浸润,并见导管上皮及腺腔内中性粒细胞浸润;免疫组化仅显示个别Ig G4阳性细胞。结论 AIP是一种特殊类型的慢性胰腺炎,两个亚型临床病理特点存在差异,本病预后良好,正确的诊断对临床治疗有重要指导意义。

Objective To investigate the clinical and pathological features,diagnosis,and differential diagnosis of two subtypes of auto-immune pancreatitis（ AIP）. Methods Combined with the clinical history,3 cases of AIP specimen were analyzed by light microscopy and immu-nohistochemistry,and related literatures had been reviewed. Results For 2 cases of type-1 AIP,the morphology manifested dilated pancreatic duct,lymphocytes and plasma cells infiltration,and storiform fibrosis. Immunohistochemistry demonstrated IgG4 〉10/HPF,IgG4/IgG〉40%. For 1 case of type-2 AIP,the morphology manifested dilated pancreatic duct,lymphocytes and plasma cells infiltration,and neutrophilic infiltra-tion within the lumen and epithelium of the interlobular ducts. Immunohistochemistry demonstrated few IgG4 positive cells. Conclusion AIP is a form of idiopathic chronic pancreatitis. The clinical and pathological features of two subtypes are different. The prognosis of AIP is good. The cor-rect diagnosis has guiding significance for clinical therapy.