San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Am J Clin Pathol. 2013 Mar;139(3):323-9. doi: 10.1309/AJCPT00NHQHXAHDS.
Endoscopic ampullary biopsies showing increased immunoglobulin (Ig) G4+ plasma cells have been reported as an alternative to pancreatic biopsy in diagnosing autoimmune pancreatitis (AIP). This study assessed whether increased IgG4+ cells can be seen outside the context of AIP. Fifty-four cases (45 duodenal or ampullary biopsies, 9 ampullae from pancreatic resections) were selected, and all specimens were immunostained for IgG4 and IgG. Duodenal or ampullary biopsies containing normal duodenal mucosa (n = 6) and increased intraepithelial lymphocytes without villous blunting (n = 7) were negative for IgG4. Increased IgG4+ cells (>10 per high-power field) were found in 7 cases of 18 serologically confirmed celiac disease patients and in 3 of 14 patients with duodenitis or gastric heterotopias. Two of 6 ampullae from patients with pancreatic cancer showed increased IgG4+ cells. In summary, 12 of 51 patients without AIP had duodenal biopsies or ampullae showing increased IgG4+ plasma cells. The finding of increased IgG4+ cells in duodenal biopsies is not specific for AIP without the correct clinical context.
内镜壶腹活检显示免疫球蛋白 (Ig) G4+浆细胞增多已被报道可替代胰腺活检用于诊断自身免疫性胰腺炎 (AIP)。本研究评估了在 AIP 之外是否可以观察到增多的 IgG4+细胞。选择了 54 例病例（45 例十二指肠或壶腹活检，9 例胰腺切除的壶腹），所有标本均进行 IgG4 和 IgG 的免疫组化染色。含有正常十二指肠黏膜的十二指肠或壶腹活检 (n=6) 和无绒毛变钝的上皮内淋巴细胞增多 (n=7) 的 IgG4 为阴性。在 18 例血清学确诊的乳糜泻患者的 7 例和 14 例胃炎或胃异位患者的 3 例中发现了增多的 IgG4+细胞 (>10 个高倍视野)。2 例胰腺癌患者的 6 个壶腹中显示 IgG4+细胞增多。总之，在 51 例无 AIP 的患者中，有 12 例十二指肠活检或壶腹显示 IgG4+浆细胞增多。在没有正确临床背景的情况下，在十二指肠活检中发现增多的 IgG4+细胞并不特异于 AIP。
