Abstract
IgG4-SC is a characteristic type of sclerosing cholangitis with increased serum IgG4 levels and dense infiltration of IgG4-positive plasma cells with extensive fibrosis in the bile duct wall. Histopathologic examination is always necessary for the definite diagnosis of IgG4-SC if there are no other organ involvements such as type 1 AIP, IgG4-related sialadenits or retroperitoneal fibrosis. Endobiliary biopsy by ERC is a standard technique for tissue acquisition of bile duct. However, it is not easy to obtain sufficient bile duct tissue to study the characteristic histology of IgG4-SC biopsy specimens because fibroinflammatory involvement is observed mainly in the submucosa of the bile duct wall, whereas the epithelium of the bile duct is sometimes intact. Liver biopsy can be useful and diagnostic if IgG4-SC involve intrahepatic small bile duct and be considered as a last tissue acquisition method if endobiliary biopsy is nondiagnostic.
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References
Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25:1181–92.
Alswat K, Al-Harthy N, Mazrani W, Alshumrani G, Jhaveri K, Hirschfield GM. The spectrum of sclerosing cholangitis and the relevance of IgG4 elevations in routine practice. Am J Gastroenterol. 2012;107:56–63.
Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–15.
Ohara H, Okazaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci. 2012;19:536–42.
Nakazawa T, Ohara H, Sano H, Ando T, Joh T. Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas. 2006;32:229.
Rustgi AK, Kelsey PB, Guelrud M, et al. Malignant tumors of the bile ducts: diagnosis by biopsy during endoscopic cannulation. Gastrointest Endosc. 1989;35(3):248–51.
Schoefl R, Haefner M, Wrba F. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–8.
Korc P, Sherman S. ERCP tissue sampling. Gastrointest Endosc. 2016;84:557–71.
Nakanuma Y, Zen Y. Pathology and immunopathology of immunoglobulin G4-related sclerosing cholangitis: the latest addition to the sclerosing cholangitis family. Hepatol Res. 2007;37(Suppl 3):S478–86.
Kawakami H, Kuwatani M, Etoh K, et al. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy. 2009;41:959–64.
Itoi T, Osanai M, Igarashi Y, et al. Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions. Clin Gastroenterol Hepatol. 2010;8:934–8.
Navaneethan U, Hasan MK, Lourdusamy V. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015;82:608–14.
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© 2019 Springer Science+Business Media Singapore
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Ryu, J.K. (2019). Tissue Acquisition for Histologic Diagnosis. In: Kamisawa, T., Kim, MH. (eds) IgG4-Related Sclerosing Cholangitis. Springer, Singapore. https://doi.org/10.1007/978-981-10-4548-6_14
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DOI: https://doi.org/10.1007/978-981-10-4548-6_14
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