Diffuse irregular narrowing of the main pancreatic duct, and stenosis of the intrapancreatic bile duct on endoscopic retrograde cholangiopancreatography (ERCP). Rare pancreatic calcification or cyst formation. Marked responsiveness to treatment with corticosteroids. Histopathology
Histopathologic examination of the pancreas reveals a characteristic lymphoplasmacytic infiltrate of CD4- or CD8-positive lymphocytes and IgG4-positive plasma cells, and exhibits interstitial fibrosis and acinar cell atrophy in later stages. At the initial stages, typically, there is a cuff of lymphoplasma cells surrounding the ducts but also more diffuse infiltration in the lobular parenchyma. However, localization and the degree of duct wall infiltration are variable. Whereas histopathologic examination remains the primary method for differentiation of AIP from acute and chronic pancreatitis, lymphoma, and cancer. By Fine Needle Aspiration (FNA) the diagnosis can be made if adequate tissue is obtained. In such cases, lymphoplasmacytic infiltration of the lobules are the key finding. Rarely, granulomatous reaction could be observed. It has been proposed that a cytologic smear primarily composed of acini rich in  chronic inflammatory cells (lymphocytes, plasma cells), with rare ductal epithelial cells lacking atypia, favors the diagnosis of AIP. The sensitivity and the specificity of these criteria for differentiating AIP from neoplasia are unknown.
Celecoxib/tramadol sold under the brand name Seglentis, is a fixed-dose combination of the anti-inflammatory celecoxib and the opioid tramadol used for the management and treatment of pain.Developed by Spanish pharmaceutical company Esteve, it was approved for medical use in the United States in October 2021. References
External links
"Celecoxib". Drug Information Portal. U.S. National Library of Medicine. "Tramadol hydrochloride". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT03108482 for "Co-crystal E-58425 vs Tramadol and Celecoxib for Moderate to Severe Acute Pain After Bunionectomy. Phase III Clinical Trial." at ClinicalTrials.gov