Small bile duct involvement in IgG4-related sclerosing cholangitis: liver biopsy and cholangiography correlation.
BACKGROUND
IgG4-related sclerosing cholangitis (IgG4-SC) needs to be differentiated from primary sclerosing cholangitis (PSC). In this study, we performed a retrospective study to reveal cases in which liver needle biopsy was useful for differential diagnosis.


METHODS
Nineteen patients with IgG4-SC and 22 patients with PSC were studied. All patients underwent endoscopic retrograde cholangiography and liver needle biopsy. We defined small bile duct involvement of IgG4-SC histologically as damage to the small bile duct associated with infiltration of ≥10 IgG4+ plasma cells per high power field (HPF). Clinicopathological characteristics were compared between IgG4-SC patients with and without small bile duct involvement.


RESULTS
Small bile duct involvement was observed in 5 (26%) of the patients with IgG4-SC. Patients with small bile duct involvement showed a higher incidence of intrahepatic biliary strictures on cholangiography (80 vs. 21%, p = 0.038). Conversely, 4 of 7 (57%) patients with intrahepatic biliary strictures on cholangiography had histologically evident small duct involvement. The number of IgG4+ plasma cells was significantly correlated with the site of the most proximal stricture on cholangiograms (p = 0.021). The number of IgG4+ plasma cells per HPF was significantly higher in IgG4-SC patients with intrahepatic biliary strictures than in those with PSC (13.4 vs. 0.4 cells/HPF, p < 0.001).


CONCLUSIONS
Involvement of small bile ducts is more frequent in patients with intrahepatic biliary strictures on cholangiography, and liver needle biopsy is especially useful for these patients.
Naitoh
Itaru
I
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Zen
Yoh
Y
Nakazawa
Takahiro
T
Ando
Tomoaki
T
Hayashi
Kazuki
K
Okumura
Fumihiro
F
Miyabe
Katsuyuki
K
Yoshida
Michihiro
M
Nojiri
Shunsuke
S
Kanematsu
Takayoshi
T
Ohara
Hirotaka
H
Joh
Takashi
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000276:immunology / Q000473:pathology; D001707:Biopsy, Needle; D002648:Child; D002758:Cholangiography; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology*; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult
D007074:Immunoglobulin G
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