The Use of Immunoglobulin G4 Immunostaining in Diagnosing Pancreatic and Extrapancreatic Involvement in Autoimmune Pancreatitis  Maesha G. Deheragoda, Nicholas I. Church, Manuel Rodriguez–Justo, Philippa Munson, Neomal Sandanayake, Edward W. Seward, Keith Miller, Marco Novelli, Adrian R.W. Hatfield, Stephen P. Pereira, George J.M. Webster  Clinical Gastroenterology and Hepatology  Volume 5, Issue 10, Pages 1229-1234 (October 2007) DOI: 10.1016/j.cgh.2007.04.023 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 (A) H&E-stained section (magnification, 100×) of pancreatic biopsy specimen from patient 10 showing fibrosis, a lymphoplasmacytic infiltrate within pancreatic lobules, with nuclear streaming artifact surrounding a venule showing obliterative phlebitis (V). There is relative preservation of arterioles (A). (B) H&E-stained section of pancreatic biopsy from patient 10 (magnification, 200×) with a lymphoplasmacytic infiltrate surrounding pancreatic ducts (D). There is atrophy of exocrine pancreatic tissue with preservation of islets (I). (C) IgG4 immunostaining of plasma cells within the pancreatic biopsy from patient 10 (magnification, 400×). (D) H&E-stained section (magnification, 100×) of liver biopsy from patient 6 showing the lymphoplasmacytic infiltrate within portal tracts. (E) H&E-stained section of a portal tract from the liver biopsy on patient 6 showing the features of large duct obstruction with a mild increase in eosinophils and nuclear streaming artifact (N) (magnification, 200×). (F) IgG4 immunostaining of plasma cells within portal tracts from the liver biopsy on patient 6 (magnification, 400×). (G) H&E-stained section (magnification, 100×) of salivary gland from patient 3 showing a lymphoplasmacytic infiltrate with lymphoid follicle formation. (H) H&E-stained section (magnification, 200×) of salivary gland from patient 3 showing a lymphoplasmacytic infiltrate and nuclear streaming artifact (N) within lobules (magnification, 200×). (I) IgG4 immunostaining of plasma cells within salivary gland from patient 3 (magnification, 400×). (J) H&E-stained section (magnification, 100×) of duodenum from patient 3. (K) H&E-stained section of duodenal biopsy from patient 3 (magnification, 200×) of duodenum showing fibrosis with nuclear streaming artifact (N) and a lymphoplasmacytic infiltrate with a prominence of eosinophils (E). (L) IgG4 immunostaining of duodenal biopsy from patient 3 (magnification, 400×). Plasma cells expressing IgG4 were identified on the basis of CD138 staining of adjacent tissue sections and characteristic plasma cell morphology (an eccentrically placed nucleus that has a clock face appearance and abundant cytoplasm). Clinical Gastroenterology and Hepatology 2007 5, 1229-1234DOI: (10.1016/j.cgh.2007.04.023) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 Mean numbers of IgG4-positive plasma cells in AIP patients vs normal and inflamed controls. SG, salivary gland. Clinical Gastroenterology and Hepatology 2007 5, 1229-1234DOI: (10.1016/j.cgh.2007.04.023) Copyright © 2007 AGA Institute Terms and Conditions