title: Histological evaluation of obliterative phlebitis for the diagnosis of autoimmune pancreatitis.
abstract: BACKGROUND
  Obliterative phlebitis is a useful pathological finding for the diagnosis of lymphoplasmacytic sclerosing pancreatitis (LPSP), or type 1 autoimmune pancreatitis. The present study evaluated histological findings of obliterative phlebitis, including the significance of adding Elastica van Gieson stain (EVG) in comparison with other pancreatic conditions.
  
  
  METHODS
  Specimens of LPSP (n = 18), chronic pancreatitis (CP; n = 24), and pancreatic ductal adenocarcinoma (PDA; n = 45) were enrolled. Obliterative venous lesions (OVLs), defined as the presence of inflammatory cells and/or fibrosis inside the tunica adventitia, were counted and compared between hematoxylin and eosin stain (H&E) and EVG. OVLs were classified into three types: OVL-1, lymphoplasmacytic infiltration and fibrosis against a loose textured background; OVL-2, dense fibrosis with minimal or no lymphoplasmacytic infiltration; and OVL-3, densely packed lymphoplasmacytic infiltration without fibrosis. OVL type and OVL size were compared between disease groups.
  
  
  RESULTS
  OVL counts in LPSP, CP, and PDA were significantly higher with EVG than with H&E (p < 0.001). OVL-1 was most common in LPSP (H&E 92.4 %, EVG 79.8 %), and was identified in almost all cases of LPSP, but was less common in CP and PDA. Maximum diameter and OVL count in 1 cm(2) of OVL-1 were high for LPSP. Maximum diameter of OVL-1 ≥150 μm was observed in 17 LPSP, 0 CP, and 1 PDA cases (sensitivity 94.4 %, specificity 98.6 %).
  
  
  CONCLUSIONS
  Additional EVG is useful for excluding conditions mimicking OVL-1 or detecting OVL in small specimens. The presence of OVL-1 with diameter ≥150 μm is highly diagnostic for LPSP.
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
authors: Katsuyuki
authors: K
authors: Miyabe
authors: Kenji
authors: K
authors: Notohara
authors: Takahiro
authors: T
authors: Nakazawa
authors: Kazuki
authors: K
authors: Hayashi
authors: Itaru
authors: I
authors: Naitoh
authors: Fumihiro
authors: F
authors: Okumura
authors: Shuya
authors: S
authors: Shimizu
authors: Michihiro
authors: M
authors: Yoshida
authors: Hiroaki
authors: H
authors: Yamashita
authors: Satoru
authors: S
authors: Takahashi
authors: Hirotaka
authors: H
authors: Ohara
authors: Takashi
authors: T
authors: Joh
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D063194:Adventitia / Q000473:pathology; D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis*; D050500:Pancreatitis, Chronic / Q000175:diagnosis*; D010689:Phlebitis / Q000145:classification / Q000150:complications / Q000473:pathology*; D013194:Staining and Labeling; D055815:Young Adult
chemical_list: D004396:Coloring Agents
references: J Gastroenterol. 2003;38(4):315-26
references: 12743770
references: J Hepatobiliary Pancreat Sci. 2011 Mar;18(2):127-36
references: 20814701
references: J Clin Pathol. 2008 Oct;61(10):1093-7
references: 18682417
references: J Clin Pathol. 1970 Nov;23(8):681-9
references: 5488039
references: Pancreas. 2011 Apr;40(3):352-8
references: 21412117
references: Pancreas. 2005 May;30(4):355-8
references: 15841047
references: Am J Gastroenterol. 2009 Sep;104(9):2295-306
references: 19532132
references: Pathol Int. 2008 Jul;58(7):421-6
references: 18577110
references: Biom J. 2005 Aug;47(4):458-72
references: 16161804
references: Clin Gastroenterol Hepatol. 2003 Mar;1(2):129-35
references: 15017505
references: Pancreas. 1997 Apr;14(3):215-21
references: 9094150
references: N Engl J Med. 2012 Feb 9;366(6):539-51
references: 22316447
references: N Engl J Med. 2001 Mar 8;344(10):732-8
references: 11236777
references: Curr Opin Rheumatol. 2011 Jan;23(1):74-9
references: 21124089
references: J Gastroenterol Hepatol. 2004 Sep;19(9):998-1004
references: 15304116
references: Mod Pathol. 2009 Mar;22(3):351-8
references: 19136927
references: Am J Gastroenterol. 2009 Sep;104(9):2288-94
references: 19568232
references: Am J Gastroenterol. 2007 Aug;102(8):1646-53
references: 17555461
references: Am J Gastroenterol. 1994 Nov;89(11):2060-2
references: 7942737
references: Cancer. 1950 Jan;3(1):32-5
references: 15405679
references: Histopathology. 2001 Feb;38(2):105-10
references: 11207823
references: Am J Surg Pathol. 2008 May;32(5):671-81
references: 18344866
references: J Gastroenterol. 2006 Jul;41(7):626-31
references: 16932998
references: Mod Pathol. 2012 Sep;25(9):1181-92
references: 22596100
references: Virchows Arch. 2004 Dec;445(6):552-63
references: 15517359
references: J Gastroenterol. 2007 May;42 Suppl 18:6-8
references: 17520216
references: Mod Pathol. 2007 Jan;20(1):23-8
references: 16980948
references: Am J Surg Pathol. 2006 Dec;30(12):1537-45
references: 17122509
references: Gastroenterology. 2008 Mar;134(3):706-15
references: 18222442
references: Am J Surg Pathol. 2007 Apr;31(4):643-5
references: 17414116
references: Pancreas. 2010 Jul;39(5):549-54
references: 20562576
references: World J Gastroenterol. 2006 Apr 28;12(16):2487-96
references: 16688792
references: Hum Pathol. 1991 Apr;22(4):387-95
references: 2050373
references: Clin Gastroenterol Hepatol. 2009 Oct;7(10):1097-103
references: 19410017
references: Gut. 1984 Jul;25(7):756-9
references: 6735257
references: Gut. 2009 Dec;58(12):1680-9
references: 19240063
references: Lancet. 2002 Apr 20;359(9315):1403-4
references: 11978339
references: J Gastroenterol. 2010 May;45(5):471-7
references: 20213336
references: Virchows Arch A Pathol Anat Histol. 1978 Apr 17;377(4):339-49
references: 150106
references: Mod Pathol. 2007 Aug;20(8):884-94
references: 17571078
references: Am J Surg Pathol. 2003 Aug;27(8):1119-27
references: 12883244
references: Pancreas. 2008 Jan;36(1):84-9
references: 18192887
references: Clin Gastroenterol Hepatol. 2007 Oct;5(10):1229-34
references: 17702660
references: Cancer Causes Control. 2006 May;17(4):403-9
references: 16596292
references: Am J Surg Pathol. 2009 Dec;33(12):1886-93
references: 19898222
references: Biometrics. 1988 Sep;44(3):837-45
references: 3203132
references: Clin Gastroenterol Hepatol. 2006 Aug;4(8):1010-6; quiz 934
references: 16843735
references: Endoscopy. 2006 Jun;38 Suppl 1:S30-5
references: 16802220
references: Am J Clin Pathol. 1976 Mar;65(3):274-83
references: 943929
references: J Gastroenterol. 2008;43(6):403-8
references: 18600383
references: Surv Ophthalmol. 1996 Jul-Aug;41(1):66-78
references: 8827931