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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Diagnostic criteria for autoimmune pancreatitis

Diagnostic criteria for autoimmune pancreatitis
Criterion Level 1 Level 2
P Parenchymal imaging Typical:
  • Diffuse enlargement with delayed enhancement (sometimes associated with rim-like enhancement)
Indeterminate (including atypical*):
  • Segmental/focal enlargement with delayed enhancement
D Ductal imaging (ERP) Long (greater than one-third length of the main pancreatic duct) or multiple strictures without marked upstream dilatation Segmental/focal narrowing without marked upstream dilatation (duct size, <5 mm)
S Serology IgG4, >2× upper limit of normal value IgG4, 1 to 2× upper limit of normal value
OOI Other organ involvement a or b a or b
  1. Histology of extrapancreatic organs
    Any three of the following:
    1. Marked lymphoplasmacytic infiltration with fibrosis and without granulocytic infiltration
    2. Storiform fibrosis
    3. Obliterative phlebitis
    4. Abundant (>10 cells/HPF) IgG4-positive cells
  2. Typical radiologic evidence
    At least one of the following:
    1. Segmental/multiple proximal (hilar/intrahepatic) or proximal and distal bile duct stricture
    2. Retroperitoneal fibrosis
  1. Histology of extrapancreatic organs including endoscopic biopsies of bile duct
    Both of the following:
    1. Marked lymphoplasmacytic infiltration without granulocytic infiltration
    2. Abundant (>10 cells/HPF) IgG4-positive cells
  2. Physical or radiologic evidence
    At least one of the following:
    1. Symmetrically enlarged salivary/lachrymal glands
    2. Radiologic evidence of renal involvement described in association with AIP
H Histology of the pancreas LPSP (core biopsy/resection) LPSP (core biopsy)
At least 3 of the following:
  1. Periductal lymphoplasmacytic infiltrate without granulocytic infiltration
  2. Obliterative phlebitis
  3. Storiform fibrosis
  4. Abundant (>10 cells/HPF) IgG4-positive cells
Any 2 of the following:
  1. Periductal lymphoplasmacytic infiltrate without granulocytic infiltration
  2. Obliterative phlebitis
  3. Storiform fibrosis
  4. Abundant (>10 cells/HPF) IgG4-positive cells
Response to steroid (Rt)Δ Diagnostic steroid trial
Rapid (≤2 weeks) radiologically demonstrable resolution or marked improvement in pancreatic/extrapancreatic manifestations
AIP: autoimmune pancreatitis; ERP: endoscopic retrograde pancreatogram; IgG4: immunoglobulin G4; HPF: high-power field; LPSP: lymphoplasmacytic sclerosing pancreatitis.
* Atypical: Some AIP cases may show low-density mass, pancreatic ductal dilatation, or distal atrophy. Such atypical imaging findings in patients with obstructive jaundice and/or pancreatic mass are highly suggestive of pancreatic cancer. Such patients should be managed as pancreatic cancer unless there is strong collateral evidence for AIP, and a thorough workup for cancer is negative (refer to UpToDate topic on autoimmune pancreatitis).
¶ Endoscopic biopsy of duodenal papilla is a useful adjunctive method because ampulla often is involved pathologically in AIP.
Δ Diagnostic steroid trial should be conducted carefully by pancreatologists only after negative workup for cancer. Refer to UpToDate content on autoimmune pancreatitis for additional details.
From: Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011; 40:352. DOI: 10.1097/MPA.0b013e3182142fd2. Copyright © 2011. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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