Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
J Gastroenterol. 2014 Apr;49(4):715-26. doi: 10.1007/s00535-013-0818-x. Epub 2013 May 4.
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.
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.
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 μm was observed in 17 LPSP, 0 CP, and 1 PDA cases (sensitivity 94.4 %, specificity 98.6 %).
Additional EVG is useful for excluding conditions mimicking OVL-1 or detecting OVL in small specimens. The presence of OVL-1 with diameter ≥150 μm is highly diagnostic for LPSP.
闭塞性静脉炎是淋巴浆细胞硬化性胰腺炎（LPSP）或 1 型自身免疫性胰腺炎的有用病理发现。本研究评估了闭塞性静脉炎的组织学发现，包括与其他胰腺疾病相比，添加弹力纤维 Van Gieson 染色（EVG）的意义。
纳入 LPSP（n=18）、慢性胰腺炎（CP；n=24）和胰腺导管腺癌（PDA；n=45）标本。定义为在外膜结缔组织内存在炎症细胞和/或纤维化的闭塞性静脉病变（OVL）在苏木精和伊红染色（H&E）和 EVG 之间进行计数和比较。OVL 分为三种类型：OVL-1，淋巴细胞浆细胞浸润和纤维化，背景疏松；OVL-2，纤维化致密，淋巴细胞浆细胞浸润极少或无；OVL-3，致密堆积的淋巴细胞浆细胞浸润，无纤维化。比较疾病组之间的 OVL 类型和 OVL 大小。
EVG 计数 LPSP、CP 和 PDA 的 OVL 计数明显高于 H&E（p<0.001）。OVL-1 在 LPSP 中最常见（H&E 92.4%，EVG 79.8%），几乎所有 LPSP 病例均可见，而在 CP 和 PDA 中较少见。LPSP 的 OVL-1 最大直径和 OVL 计数最高。17 例 LPSP、0 例 CP 和 1 例 PDA 病例的 OVL-1 最大直径≥150μm（敏感性 94.4%，特异性 98.6%）。
额外的 EVG 有助于排除类似 OVL-1 的病变或在小标本中检测 OVL。存在直径≥150μm 的 OVL-1 高度提示 LPSP。
