title: Small bile duct involvement in IgG4-related sclerosing cholangitis: liver biopsy and cholangiography correlation.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Yoh
authors.initials: Y
authors.lastname: Zen
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ando
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Okumura
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nojiri
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kanematsu
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: 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
chemical_list: D007074:Immunoglobulin G
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