Diagnostic Criteria for Autoimmune Pancreatitis by the Japan Pancreas Society
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Findings on Imaging Radiography (One Required) |
Serologic and Histologic Findings (One Required) |
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Cross-sectional Imaging |
ERCP or MRCP |
Serologic Analysis |
Pancreatic-Biliary Histologic Analysis |
Nongastrointestinal Histologic Analysis |
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Diffusely enlarged pancreas |
Segmental pancreatic ductal narrowing |
Elevated serum IgG4 level |
Periductal lympho-plasmacytic infiltration or fibrosis |
Tubulointerstitial nephritis with immune deposits within tubular basement membranes |
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Enhanced peripheral rim of hypoattenuation “halo” |
Focal pancreatic ductal narrowing |
Elevated serum IgG or gamma globulin level |
Obliterative phlebitis |
Pulmonary interstitial lymphoplasmacytic infiltration with IgG4-positive plasma cells |
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Low-attenuation mass in head of pancreas |
Diffuse pancreatic ductal narrowing |
Presence of ALA, ACA II, ASMA, or ANA |
IgG4-positive plasma cells in tissue |
Chronic sialadenitis with IgG4-positive plasma cells |
Criteria were modified from those of the Japan Pancreas Society. ERCP denotes endoscopic retrograde cholangiopancreatography, MRCP magnetic resonance cholangiopancreatography, ALA antilactoferrin antibody, ACA II anti-carbonic anhydrase II antibody, ASMA anti-smooth-muscle antibody, and ANA antinuclear body.
The presence of tissue IgG4-positive cells is not necessarily abnormal, but an increased number of infiltrating IgG4-positive plasma cells is abnormal.
Diagnostic Criteria for Autoimmune Pancreatitis in Asan Medical Center
Inclusion Criteria
Criterion I. Pancreatic imaging (essential)
- CT: Diffuse enlargement (swelling) of pancreas, and
- ERCP: Diffuse or segmental irregular narrowing of main pancreatic duct
Criterion II. Laboratory findings
- elevated levels of IgG and/or IgG4. or
- detected autoantibodies
Criterion III. Histopathologic findings: Fibrosis and lymphoplasmacytic infiltration
Criterion IV. Response to the steroid
Definite diagnosis: Criterion I and any of criterion II-IV
Diagnostic Criteria for Autoimmune Pancreatitis by Italian Group
Diagnostic criteria
- Histology and cytology
- The association with other postulated autoimmune disease
- Response to the steroid therapy
References:
- Japan Pancreas Society. Diagnostic criteria for autoimmune pancreatitis. J Jpn Pancreas Soc 2002;17:585-7.
- Finkelberg DL, Sahani D, Deshpande V, Brugge WR. Autoimmune pancreatitis. N Engl J Med. 2006 Dec 21;355(25):2670-6. [Medline]
- Kim KP, Kim MH, Kim JC, Lee SS, Seo DW, Lee SK. Diagnostic criteria for autoimmune chronic pancreatitis revisited. World J Gastroenterol. 2006 Apr 28;12(16):2487-96. [Medline]
Created: Jan 07, 2006
