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Imai S, Tahara N, Igata S, Tahara A, Bekki M, Sugiyama Y, Maeda-Ogata S, Honda A, Otsuka H, Ushijima T, Okabe Y, Kaida H, Abe T, Tanaka H, Fukumoto Y, Tayama E. Vascular/perivascular inflammation in IgG4-related disease. J Nucl Cardiol 2022; 29:2920-2933. [PMID: 34704218 DOI: 10.1007/s12350-021-02812-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is characterized by the infiltration of IgG4-positive plasma cells and fibrosclerotic inflammation in multiple organs. Although vascular complications are present in some patients with IgG4-RD, vascular and/or perivascular inflammatory activity compared to control subjects remains unknown. This study sought to investigate vascular/perivascular inflammation in IgG4-RD patients compared to control subjects using 18F-fluorodeoxyglucose-positron emission tomography combined with computed tomography (FDG-PET/CT). METHODS We examined 37 consecutive patients diagnosed as IgG4-RD (29 males, mean age of 64.3 ± 8.3 years old), who underwent FDG-PET/CT. Thirty-seven age- and gender-matched subjects without IgG4-RD were employed as controls. Vascular/perivascular inflammation was quantified by blood-normalized standardized uptake value, known as a target-to-background ratio (TBR). RESULTS All IgG4-RD patients presented with multiple region involvements. Twelve (32.4%) of the IgG4-RD patients had vascular complications, all of which appeared in the abdominal aorta. IgG4-RD patients had significantly higher TBR values in the descending aorta, abdominal aorta, and common iliac artery than control subjects. Also, IgG4-RD patients with vascular complication exhibited higher TBR values in the infra-renal aorta and common iliac artery than those without vascular complication. CONCLUSIONS We found that vascular FDG activity is significantly elevated in IgG4-RD patients regardless of vascular complication than control subjects. FDG-PET/CT is a useful modality for assessing vascular/perivascular inflammation, which may contribute vascular complication in IgG4-RD patients.
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Affiliation(s)
- Shinichi Imai
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Sachiyo Igata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Atsuko Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Shoko Maeda-Ogata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tomoyuki Ushijima
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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Oshita A, Kono Y, Miyoshi T, Suzuki M, Kazatani T, Matsuoka H, Kawakami H. Clinical Utility of Diffusion-weighted Whole-body Magnetic Resonance Imaging with Background Body Signal Suppression for Assessing and Monitoring IgG4-related Disease. Intern Med 2020; 59:951-955. [PMID: 31787698 PMCID: PMC7184072 DOI: 10.2169/internalmedicine.3712-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 77-year-old man with symptoms of chest pain was diagnosed with immunoglobulin G4 (IgG4)-related disease. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed an intense uptake in the submandibular gland, lymph nodes and abdominal aortic wall. Diffusion-weighted imaging with background body signal suppression (DWIBS) revealed signal enhancements at the same location as those of the FDG-PET/CT findings. The DWIBS signal intensity decreased after steroid treatment, so we decreased the steroid dosage. Relapse did not occur. DWIBS makes it possible to adjust the medicine dosage while confirming the therapeutic effects and will likely be a useful method for monitoring IgG4-related disease.
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Affiliation(s)
- Akira Oshita
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan
| | - Yusuke Kono
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan
| | - Toru Miyoshi
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan
| | - Moeko Suzuki
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan
| | - Takuro Kazatani
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan
| | - Hiroshi Matsuoka
- Department of General Medicine, Ehime Prefectural Central Hospital, Japan
| | - Hideo Kawakami
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan
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Hasegawa M, Sakurai Y, Nakata S, Horiuchi K, Komoda S, Mizutani S, Yuasa T. A Case of Ruptured Immunoglobulin G4-Related Periaortitis. Ann Vasc Dis 2019; 12:545-547. [PMID: 31942217 PMCID: PMC6957895 DOI: 10.3400/avd.cr.19-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An 80-year-old man had high serum immunoglobulin G4 (IgG4) concentration and fibrous thickening of the soft tissue mass surrounding the region from the abdominal aorta to the bilateral iliac arteries, suggestive of IgG4-related periaortitis. He presented to our emergency department with sudden-onset abdominal pain and lumbago. Computed tomography revealed a ruptured abdominal aorta. He was a poor candidate for open surgery due to his hostile abdomen. Therefore, endovascular aneurysm repair was performed. No consensus about the surgical indication for IgG4-related arterial disease has been reached yet. We believe that a novel indicator is needed for this disease.
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Affiliation(s)
- Masahiko Hasegawa
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Yuusuke Sakurai
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Shunsuke Nakata
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Kazutaka Horiuchi
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Satsuki Komoda
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Shinnichi Mizutani
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Takeshi Yuasa
- Department of Cardiovascular Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
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Matsuyama S, Kishigami T, Sakamoto M. A case of giant right coronary artery aneurysm due to IgG4-related disease. Gen Thorac Cardiovasc Surg 2019; 68:1453-1456. [DOI: 10.1007/s11748-019-01272-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
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5
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Matsusaka Y, Kikuchi T, Nakahara T, Iwabuchi Y, Jinzaki M. IgG4-related periarteritis of the carotid artery. QJM 2019; 112:805-806. [PMID: 30895311 DOI: 10.1093/qjmed/hcz068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Matsusaka
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - T Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - T Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Y Iwabuchi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - M Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Qi L, Mao D, Xiao L, Jin X, Li M, Hua Y. Immunoglobulin G4-related disease complicated with vascular lesions: CT findings in 21 patients. ACTA ACUST UNITED AC 2019; 25:42-49. [PMID: 30644367 DOI: 10.5152/dir.2018.18174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to analyze multislice computed tomography (MSCT) imaging features of vasculitis in immunoglobulin G4-related disease (IgG4-RD). METHODS In this retrospective study, we diagnosed 21 definite or possible IgG4-RD patients (71.4% male; mean age, 52.1±4.5 years) with vasculitis by MSCT and pathologic examination. The clinical background, laboratory analysis, pathologic results, CT images, and response to therapy were assessed and analyzed. RESULTS Under enhanced MSCT, 50 vasculitic lesions were identified and were divided into five types (types A-E) according to the CT findings on the basis of luminal changes. There were more vasculitic lesions observed below the diaphragm (n=30) than above it (n=20). Aneurysms and aneurysmal dilatation were more likely to be found in the aortaventralis (n=5), aortic arch (n=3) and iliac arteries (n=3). Most of the vascular lesions were characterized by wall thickening with a normal lumen (n=15) and slight stenosis (n=22). The affected vascular walls were all thickened between 4 and 18 mm. The walls of 19 patients (90.4%) were well circumscribed. The wall thickness of the aorta, including the aortaventralis and aortic arch, was more notable than that of the other vascular sites. Fourteen patients were followed up for 2-24 months. Wall thickness decreased in all cases. The average maximum thicknesses before and after therapy were 12.2±2.7 mm and 6.1±1.8 mm, which were significantly different (P < 0.001). The lumens of two patients were found to be slightly enlarged, while those of the other cases were unchanged after therapy. CONCLUSION IgG4-RD vascular lesions can be divided into five types, which are more likely to be present in the aorta and its main branches, and can rapidly diminish after steroid therapy. The lumen may be unchanged or slightly enlarged.
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Affiliation(s)
- Lin Qi
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, China
| | - Dingbiao Mao
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, China
| | - Li Xiao
- Department of Pathology, Huadong Hospital Fudan University, Shanghai, China
| | - Xiu Jin
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, China
| | - Ming Li
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, China
| | - Yanqing Hua
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, China
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Mizushima I, Kasashima S, Fujinaga Y, Kawano M, Ishizaka N. IgG4-related periaortitis/periarteritis: An under-recognized condition that is potentially life-threatening. Mod Rheumatol 2019; 29:240-250. [DOI: 10.1080/14397595.2018.1546367] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ichiro Mizushima
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Satomi Kasashima
- Department of Clinical Laboratory Science, Kanazawa University, Kanazawa, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuhiro Kawano
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Japan
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Lun Y, Jiang H, Xu D, Xin S, Zhang J. Contained rupture of a common iliac aneurysm associated with immunoglobulin G4-related disease. J Vasc Surg 2018; 68:1564-1565. [DOI: 10.1016/j.jvs.2017.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/10/2017] [Indexed: 11/16/2022]
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9
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Ozawa M, Fujinaga Y, Asano J, Nakamura A, Watanabe T, Ito T, Muraki T, Hamano H, Kawa S. Clinical features of IgG4-related periaortitis/periarteritis based on the analysis of 179 patients with IgG4-related disease: a case-control study. Arthritis Res Ther 2017; 19:223. [PMID: 28978347 PMCID: PMC5628426 DOI: 10.1186/s13075-017-1432-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/18/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic condition characterized by high serum immunoglobulin G4 (IgG4) concentration and IgG4-bearing plasma cell infiltration in affected organs. Although it has become evident that IgG4-RD also involves the systemic aortic/arterial system, the precise details of this condition remain unclear. The present study sought to clarify the clinical features of IgG4-related periaortitis/periarteritis. METHODS Among 223 patients with IgG4-RD, 179 (131 male, median onset age 67 years) were recruited for this study. Periaortitis/periarteritis was defined as vessel wall thickness with circumferential enhancement on contrast-enhanced computed tomography. RESULTS Periaortitis/periarteritis was identified in 65 (36.3%; 53 male) of 179 IgG-RD patients. The distribution of IgG4-related periaortitis/periarteritis could be broadly classified into five types, with the most prevalent Type 2 (44.6%) being localized at the infra-renal artery portion of the abdominal aorta and continuing to the iliac arteries. The infra-renal artery region of the abdominal aorta was most frequently involved (>80%) among IgG4-related periaortitis/periarteritis cases. Comparisons of clinical parameters between IgG4-RD patients with and without periaortitis/periarteritis revealed significantly higher propensities for older IgG4-RD onset age and highly active disease state featuring elevated serum IgG, IgG4, circulating immune complex, and soluble interleukin-2 receptor. All patients showed improvement of wall thickening after steroid therapy, although nine patients (20.9%) exhibited worsening of luminal dilatation. The main risk factor for this manifestation was prior luminal dilatation according to multivariate analysis. CONCLUSION IgG4-related periaortitis/periarteritis predominantly occurred at the infra-renal artery portion of the abdominal aorta, affected older IgG4-RD onset patients, and was prevalent in highly active disease states. As reported previously, the main risk factor for worsening luminal dilation after corticosteroid therapy was the existence of luminal dilation beforehand.
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Affiliation(s)
- Makiko Ozawa
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Junpei Asano
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Akira Nakamura
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takayuki Watanabe
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tetsuya Ito
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takashi Muraki
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Hideaki Hamano
- Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Shigeyuki Kawa
- Department of Internal Medicine, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano, 399-0781, Japan.
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10
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Clinical features and predictive value of serum inflammatory markers of perivascular involvement in immunoglobulin G4-related disease. Heart Vessels 2017; 32:1176-1185. [DOI: 10.1007/s00380-017-0987-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/28/2017] [Indexed: 12/24/2022]
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11
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Cha MJ, Chong S, Kim YS, Park B, Seo JH, Lee ES. Immunoglobulin G4–Related Periaortitis Involving the Aortic Arch Mimicking a Mediastinal Tumor. Ann Thorac Surg 2017; 103:e267-e270. [DOI: 10.1016/j.athoracsur.2016.08.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 01/03/2023]
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12
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Jun H, Jung CW. Immunoglobulin G4-Related Inflammatory Abdominal Aortic Aneurysm Associated With Myasthenia Gravis, With Contained Rupture. Vasc Endovascular Surg 2017; 50:571-574. [DOI: 10.1177/1538574416678557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Immunoglobulin (Ig) G4-related disease is reportedly among the various causes of inflammatory abdominal aortic aneurysm (IAAA). Many IgG4-related diseases are closely related to allergic constitution and autoimmune disease. We report a case of a 72-year-old man with IgG4-related IAAA associated with myasthenia gravis, with contained rupture.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
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13
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. IgG4-related cardiovascular disease. The emerging role of cardiovascular imaging. Eur J Radiol 2017; 86:169-175. [DOI: 10.1016/j.ejrad.2016.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/06/2016] [Accepted: 11/06/2016] [Indexed: 12/24/2022]
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Ichinose K, Araki S, Takatani A, Tanaka T, Kawakami A. IgG4-Related Disease With an Aortoduodenal Fistula After Abdominal Aortic Aneurysm Repair. Arthritis Rheumatol 2016; 68:2256. [PMID: 27273973 DOI: 10.1002/art.39777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/01/2016] [Indexed: 12/22/2022]
Affiliation(s)
| | - Saeko Araki
- Nagasaki University Graduate School of Biomedical Sciences
| | - Ayuko Takatani
- Nagasaki University Graduate School of Biomedical Sciences
| | | | - Atsushi Kawakami
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Affiliation(s)
- Kanae Kubo
- Department of Allergy and Rheumatology; The University of Tokyo Hospital; Tokyo Japan
| | - Kazuhiko Yamamoto
- Department of Allergy and Rheumatology; The University of Tokyo Hospital; Tokyo Japan
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16
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Stone JR, Bruneval P, Angelini A, Bartoloni G, Basso C, Batoroeva L, Buja LM, Butany J, d'Amati G, Fallon JT, Gittenberger-de Groot AC, Gouveia RH, Halushka MK, Kelly KL, Kholova I, Leone O, Litovsky SH, Maleszewski JJ, Miller DV, Mitchell RN, Preston SD, Pucci A, Radio SJ, Rodriguez ER, Sheppard MN, Suvarna SK, Tan CD, Thiene G, van der Wal AC, Veinot JP. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol 2015; 24:267-78. [PMID: 26051917 DOI: 10.1016/j.carpath.2015.05.001] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
Inflammatory diseases of the aorta include routine atherosclerosis, aortitis, periaortitis, and atherosclerosis with excessive inflammatory responses, such as inflammatory atherosclerotic aneurysms. The nomenclature and histologic features of these disorders are reviewed and discussed. In addition, diagnostic criteria are provided to distinguish between these disorders in surgical pathology specimens. An initial classification scheme is provided for aortitis and periaortitis based on the pattern of the inflammatory infiltrate: granulomatous/giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and the suppurative pattern. These inflammatory patterns are discussed in relation to specific systemic diseases including giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis (Wegener's), rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, Cogan syndrome, Behçet's disease, relapsing polychondritis, syphilitic aortitis, and bacterial and fungal infections.
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Affiliation(s)
| | | | | | | | | | | | - L Maximilian Buja
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | | | | | | | | | | | | | - Ornella Leone
- Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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17
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Bezmarevic M, Marjanovic I, Sarac M. Commentary: What Is the Appropriate Treatment of Immunoglobulin G4-Related Vascular Lesions? J Endovasc Ther 2014; 21:598-600. [DOI: 10.1583/14-4670.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Kasashima S, Kawashima A, Kasashima F, Endo M, Matsumoto Y, Kawakami K, Kayahara M, Ohta H, Yano M, Marukawa Y. Immunoglobulin G4–Related Periaortitis Complicated by Aortic Rupture and Aortoduodenal Fistula After Endovascular AAA Repair. J Endovasc Ther 2014; 21:589-97. [DOI: 10.1583/14-4670r.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Compound heterozygous CORO1A mutations in siblings with a mucocutaneous-immunodeficiency syndrome of epidermodysplasia verruciformis-HPV, molluscum contagiosum and granulomatous tuberculoid leprosy. J Clin Immunol 2014; 34:871-90. [PMID: 25073507 DOI: 10.1007/s10875-014-0074-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 06/30/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE Coronin-1A deficiency is a recently recognized autosomal recessive primary immunodeficiency caused by mutations in CORO1A (OMIM 605000) that results in T-cell lymphopenia and is classified as T(-)B(+)NK(+)severe combined immunodeficiency (SCID). Only two other CORO1A-kindred are known to date, thus the defining characteristics are not well delineated. We identified a unique CORO1A-kindred. METHODS We captured a 10-year analysis of the immune-clinical phenotypes in two affected siblings from disease debut of age 7 years. Target-specific genetic studies were pursued but unrevealing. Telomere lengths were also assessed. Whole exome sequencing (WES) uncovered the molecular diagnosis and Western blot validated findings. RESULTS We found the compound heterozygous CORO1A variants: c.248_249delCT (p.P83RfsX10) and a novel mutation c.1077delC (p.Q360RfsX44) (NM_007074.3) in two affected non-consanguineous siblings that manifested as absent CD4CD45RA(+) (naïve) T and memory B cells, low NK cells and abnormally increased double-negative (DN) ϒδ T-cells. Distinguishing characteristics were late clinical debut with an unusual mucocutaneous syndrome of epidermodysplasia verruciformis-human papilloma virus (EV-HPV), molluscum contagiosum and oral-cutaneous herpetic ulcers; the older female sibling also had a disfiguring granulomatous tuberculoid leprosy. Both had bilateral bronchiectasis and the female died of EBV+ lymphomas at age 16 years. The younger surviving male, without malignancy, had reproducibly very short telomere lengths, not before appreciated in CORO1A mutations. CONCLUSION We reveal the third CORO1A-mutated kindred, with the immune phenotype of abnormal naïve CD4 and DN T-cells and newfound characteristics of a late/hypomorphic-like SCID of an EV-HPV mucocutaneous syndrome with also B and NK defects and shortened telomeres. Our findings contribute to the elucidation of the CORO1A-SCID-CID spectrum.
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20
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Mizushima I, Inoue D, Yamamoto M, Yamada K, Saeki T, Ubara Y, Matsui S, Masaki Y, Wada T, Kasashima S, Harada K, Takahashi H, Notohara K, Nakanuma Y, Umehara H, Yamagishi M, Kawano M. Clinical course after corticosteroid therapy in IgG4-related aortitis/periaortitis and periarteritis: a retrospective multicenter study. Arthritis Res Ther 2014; 16:R156. [PMID: 25056443 PMCID: PMC4220557 DOI: 10.1186/ar4671] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/08/2014] [Indexed: 12/14/2022] Open
Abstract
Introduction Immunoglobulin G4 (IgG4)–related aortitis/periaortitis and periarteritis are vascular manifestations of IgG4-related disease. In this disease, the affected aneurysmal lesion has been suspected to be at risk of rupture. In this study, we aimed to clarify the clinical course after corticosteroid therapy in IgG4-related aortitis/periaortitis and periarteritis. Methods We retrospectively evaluated clinical features, including laboratory data, imaging findings and the course after corticosteroid therapy, in 40 patients diagnosed with IgG4-related aortitis/periaortitis and periarteritis on the basis of periaortic/periarterial radiological findings, satisfaction of the comprehensive diagnostic criteria or each organ-specific diagnostic criteria, and exclusion of other diseases. Results The patients were mainly elderly, with an average age of 66.4 years and with a marked male predominance and extensive other organ involvement. Subjective symptoms were scanty, and only a small proportion had elevated serum C-reactive protein levels. The affected aorta/artery were the abdominal aortas or the iliac arteries in most cases. Thirty-six patients were treated with prednisolone, and the periaortic/periarterial lesions improved in most of them during the follow-up period. Two (50.0%) of four patients with luminal dilatation of the affected lesions before corticosteroid therapy had exacerbations of luminal dilatation after therapy, whereas none of the twenty-six patients without it had a new appearance of luminal dilatation after therapy. Conclusions The results of this retrospective multicenter study highlight three important points: (1) the possibility of latent existence and progression of periaortic/periarterial lesions, (2) the efficacy of corticosteroid therapy in preventing new aneurysm formation in patients without luminal dilatation of periaortic/periarterial lesions and (3) the possibility that a small proportion of patients may actually develop luminal dilatation of periaortic/periarterial lesions in IgG4-related aortitis/periaortitis and periarteritis. A larger-scale prospective study is required to confirm the efficacy and safety of corticosteroid therapy in patients with versus those without luminal dilatation and to devise a more useful and safe treatment strategy, including administration of other immunosuppressants.
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21
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Pieringer H, Parzer I, Wöhrer A, Reis P, Oppl B, Zwerina J. IgG4- related disease: an orphan disease with many faces. Orphanet J Rare Dis 2014; 9:110. [PMID: 25026959 PMCID: PMC4223520 DOI: 10.1186/s13023-014-0110-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/03/2014] [Indexed: 02/07/2023] Open
Abstract
Immunoglobulin G4- related disease (IgG4-RD) is a rare systemic fibro-inflammatory disorder (ORPHA284264). Although patients have been described more than 100 years ago, the systemic nature of this disease has been recognized in the 21st century only. Type 1 autoimmune pancreatitis is the most frequent manifestation of IgG4-RD. However, IgG4-RD can affect any organ such as salivary glands, orbits, retroperitoneum and many others. Recent research enabled a clear clinical and histopathological description of IgG4-RD. Typically, lymphoplasmacellular inflammation, storiform fibrosis and obliterative phlebitis are found in IgG4-RD biopsies and the tissue invading plasma cells largely produce IgG4. Elevated serum IgG4 levels are found in many but not all patients. Consequently, diagnostic criteria for IgG4-RD have been proposed recently. Treatment is largely based on clinical experience and retrospective case series. Glucocorticoids are the mainstay of therapy, although adjunctive immunosuppressive agents are used in relapsing patients. This review summarizes current knowledge on clinical manifestations, pathophysiology and treatment of IgG4-RD.
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22
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Löffler C, Hoffend J, Rebel M, Waldherr R, Uppenkamp M, Bergner R. A rare cause for lower back pain: a case of an IgG4-related periaortitis. Clin Rheumatol 2014; 35:265-70. [DOI: 10.1007/s10067-014-2535-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/09/2014] [Indexed: 12/24/2022]
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23
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Immunoglobulin G4–related multiple systemic aneurysms and splenic aneurysm rupture during steroid therapy. Hum Pathol 2014; 45:175-9. [DOI: 10.1016/j.humpath.2013.07.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/22/2013] [Accepted: 07/31/2013] [Indexed: 12/24/2022]
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24
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Affiliation(s)
- Miyu Tajima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine
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25
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Abstract
Recognition of IgG4-related disease as an independent chronic inflammatory disorder is a relatively new concept; previously, the condition was thought to represent a subtype of Sjögren's syndrome. IgG4-related disease is characterized by elevated serum levels of IgG4 and inflammation of various organs, with abundant infiltration of IgG4-bearing plasma cells, storiform fibrosis and obliterative phlebitis representing the major histopathological features of the swollen organs. The aetiology and pathogenesis of this disorder remain unclear, but inflammation and subsequent fibrosis occur due to excess production of type 2 T-helper-cell and regulatory T-cell cytokines. The disease can comprise various organ manifestations, such as dacryoadenitis and sialadenitis (also called Mikulicz disease), type 1 autoimmune pancreatitis, kidney dysfunction and lung disease. Early intervention using glucocorticoids can improve IgG4-related organ dysfunction; however, patients often relapse when doses of these agents are tapered. The disease has also been associated with an increased incidence of certain malignancies. Increased awareness of IgG4-related disease might lead to consultation with rheumatologists owing to its clinical, and potentially pathogenetic, similarities with certain rheumatic disorders. With this in mind, we describe the pathogenic mechanisms of IgG4-related disease, and outline considerations for diagnosis and treatment of the condition.
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26
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Zen Y, Kasashima S, Inoue D. Retroperitoneal and aortic manifestations of immunoglobulin G4-related disease. Semin Diagn Pathol 2012; 29:212-8. [PMID: 23068300 DOI: 10.1053/j.semdp.2012.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Retroperitoneal fibrosis is one of the prototypic manifestations of immunoglobulin G4 (IgG4)-related disease (IgG4-RD), but there is growing evidence that the aorta is also involved. These 2 conditions are closely linked, and based on the epicenter of the disease, the clinical manifestations can be classified as retroperitoneal fibrosis, inflammatory abdominal aortic aneurysm (including a combination of the 2), and thoracic aortitis. IgG4-RD is responsible for only a subset (∼50%) of cases of retroperitoneal fibrosis and inflammatory aortic aneurysms. Histological features include an extensive lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, fibrosis arranged in a storiform pattern, moderate tissue eosinophilia, and partially or completely obliterated veins. Among the 3 layers comprising the aorta, the adventitia is most susceptible to IgG4-related inflammation. The inflammatory process can also disrupt the lamellar elastic fibers in the media, which is seemingly a critical event leading to aneurysmal transformation. Steroid therapy is effective for both retroperitoneal and aortic lesions, as it is for the other manifestations of IgG4-RD. The risk of rupture appears to be low in patients with IgG4-related aortic aneurysms, but immunosuppressive therapy may trigger this critical complication by reducing the wall thickness.
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Affiliation(s)
- Yoh Zen
- Histopathology Section, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.
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27
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Kasashima S, Kawashima A, Endo M, Matsumoto Y, Kasashima F, Zen Y, Nakanuma Y. A clinicopathologic study of immunoglobulin G4-related disease of the femoral and popliteal arteries in the spectrum of immunoglobulin G4-related periarteritis. J Vasc Surg 2012; 57:816-22. [PMID: 23159475 DOI: 10.1016/j.jvs.2012.08.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/01/2012] [Accepted: 08/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Immunoglobulin (Ig) G4-related disease has recently been recognized to occur in the cardiovascular system in the aorta and main branching arteries, often manifesting as aneurysms and arteritis/periarteritis. Peripheral arteries (the femoral and popliteal arteries) are frequent sites of arteriosclerosis obliterans (ASO) and occasionally show aneurysms or arteritis. This study re-examined peripheral arterial lesions from the standpoint of IgG4-related disease. METHODS The study comprised 104 patients who underwent surgical treatment of peripheral arterial lesions, including 30 patients with peripheral arterial aneurysms (PAAs) and 74 with ASO. IgG4-related disease was identified on the basis of diffuse infiltration of numerous IgG4-positive plasmacytes as revealed by immunohistochemical examination. Clinicopathologic features were compared between IgG4-related and IgG4-unrelated lesions. RESULTS IgG4-related disease was found in four of the 30 patients with PAAs (13.3%; two in the deep femoral artery, two in the popliteal artery) but not in any patients with ASO. IgG4-related PAA displayed clinicopathologic features resembling those of other IgG4-related diseases and a characteristic saccular appearance (P = .002). CONCLUSIONS IgG4-related disease was detected in PAA patients but not in ASO patients. IgG4-related disease thus represents one potential etiology of aneurysm in the peripheral arteries.
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Affiliation(s)
- Satomi Kasashima
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
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28
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Dense IgG4 plasma cell infiltrates associated with chronic infectious aortitis: implications for the diagnosis of IgG4-related disease. Cardiovasc Pathol 2012; 21:470-5. [DOI: 10.1016/j.carpath.2012.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 12/24/2022] Open
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IgG4-related sclerosing disease of the small bowel presenting as necrotizing mesenteric arteritis and a solitary jejunal ulcer. Am J Surg Pathol 2012; 36:929-34. [PMID: 22367294 DOI: 10.1097/pas.0b013e3182495c96] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Since first described in the mid 1990s, there has been burgeoning literature on IgG4-related sclerosing disease. The number of sites that may be involved is ever increasing, with the pancreas, salivary glands, and lymph nodes being the most commonly affected organs. There are no well-documented cases arising in the gastrointestinal tract. In this report, we present the first case to our knowledge of IgG4-related sclerosing disease involving the small bowel with a distinctly unusual clinicopathologic presentation. A previously well 46-year-old woman presented with a 2-year history of intermittent abdominal pain with recent worsening due to small bowel obstruction. Following imaging, which showed jejunitis with surrounding mesenteric inflammatory changes, she proceeded to a segmental small bowel resection. The resected jejunum revealed an isolated, stenosing chronic ulcer associated with a necrotizing mesenteric arteritis. A transmural inflammatory infiltrate rich in IgG4 plasma cells was seen in the wall of the bowel and mesenteric artery. Abundant IgG4 interfollicular plasma cells were also identified in a mesenteric lymph node. The serum IgG4 level was elevated at >800 mg/dL (reference range 8 to 140 mg/dL). Although phlebitis is an almost constant feature of this disease, arteritis is not described other than in the lung and aorta. In this report, we also discuss the diagnostic pitfalls and the differential diagnoses that should be considered when this condition arises in the gastrointestinal tract.
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30
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Koole D, Hurks R, Schoneveld A, Vink A, Golledge J, Moran CS, de Kleijn DP, van Herwaarden JA, de Vries JP, Laman JD, Huizinga R, Pasterkamp G, Moll FL. Osteoprotegerin Is Associated With Aneurysm Diameter and Proteolysis in Abdominal Aortic Aneurysm Disease. Arterioscler Thromb Vasc Biol 2012; 32:1497-504. [DOI: 10.1161/atvbaha.111.243592] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective—
Serum osteoprotegerin (OPG) concentrations have previously been associated with growth of abdominal aortic aneurysms (AAAs). In vitro experiments showed that OPG promotes matrix metalloprotease (MMP) release from monocytes and vascular smooth muscle cells. We hypothesized that OPG expression is increased in human AAAs and is associated with proteolysis.
Methods and Results—
AAA biopsies were collected from 329 patients. We assessed the concentrations of OPG, cathepsins A, B, and S as well as the activity of MMP-2 and MMP-9. The AAA wall infiltration by macrophages, lymphocytes, and plasma cells was estimated by immunohistochemistry. The concentration of OPG correlated positively with aortic diameter (<55 mm: 16.1 [5.8–28.7], 55–70 mm: 21.9 [10.2–36.0], >70 mm: 24.0 [13.5–52.9] ng OPG/mg total amount of protein,
P
=0.020), cathepsin A (
r
=0.221,
P
=0.005), B (
r
=0.384,
P
<0.001), and S (
r
=0.467, P<0.001), MMP-2 (
r
=0.180,
P
<0.001), MMP-9 (
r
=0.178, P<0.001), and the number of lymphocytes (
P
<0.001) and plasma cells (
P
=0.001). OPG immunostaining was predominantly demonstrated in plasma cells.
Conclusion—
The concentration of aortic wall OPG is positively associated with established markers of AAA severity and pathogenesis. OPG appeared to be associated with lymphocytes and plasma cells. These human data support previous experimental data suggesting a role for OPG in AAA pathogenesis.
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Affiliation(s)
- Dave Koole
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Rob Hurks
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Arjan Schoneveld
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Aryan Vink
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Jonathan Golledge
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Corey S. Moran
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Dominique P. de Kleijn
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Joost A. van Herwaarden
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Jean-Paul de Vries
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Jon D. Laman
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Ruth Huizinga
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Gerard Pasterkamp
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
| | - Frans L. Moll
- From the Department of Vascular Surgery (D.K., R.H., J.v.H., F.L.M.), Department of Experimental Cardiology (D.K., R.H., A.S., D.P.d.K., G.P.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, Harvard Medical School, Boston, MA (R.H.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (A.S., D.P.d.K.); Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia
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Shu HJ, Tan B, Xue HD, Yang AM, Qian JM. IgG4-related sclerosing cholangitis with autoimmune pancreatitis and periaortitis: case report and review of the literature. J Dig Dis 2012; 13:280-6. [PMID: 22500791 DOI: 10.1111/j.1751-2980.2012.00585.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hui Jun Shu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
Immunoglobulin G4-related systemic disease (IgG4-RSD) is a recently defined emerging entity characterized by a diffuse or mass forming inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosclerosis and obliterative phlebitis. IgG4-RSD usually affects middle aged and elderly patients, with a male predominance. It is associated with an elevated serum titer of IgG4, which acts as a marker for this recently characterized entity. The prototype is IgG4-related sclerosing pancreatitis or autoimmune pancreatitis (AIP). Other common sites of involvement are the hepatobiliary tract, salivary gland, orbit, and lymph node, however practically any organ can be involved, including upper aerodigestive tract, lung, aorta, mediastinum, retroperitoneum, soft tissue, skin, central nervous system, breast, kidney, and prostate. Fever or constitutional symptoms usually do not comprise part of the clinical picture. Laboratory findings detected include raised serum globulin, IgG and IgG4. An association with autoantibody detection (such as antinuclear antibodies and rheumatoid factor) is seen in some cases. Steroid therapy comprises the mainstay of treatment. Disease progression with involvement of multiple organ-sites may be encountered in a subset of cases and may follow a relapsing-remitting course. The principal histopathologic findings in several extranodal sites include lymphoplasmacytic infiltration, lymphoid follicle formation, sclerosis and obliterative phlebitis, along with atrophy and destruction of tissues. Immunohistochemical staining shows increased IgG4+ cells in the involved tissues (>50 per high-power field, with IgG4/IgG ratio >40%). IgG4-RSD may potentially be rarely associated with the development of lymphoma and carcinoma. However, the nature and pathogenesis of IgG4-RSD are yet to be fully elucidated and provide immense scope for further studies.
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Affiliation(s)
- Mukul Divatia
- Department of Pathology, The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Sun A Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Y. Ro
- Department of Pathology, The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- National Cancer Center, Goyang, Korea
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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33
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Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Yoshikawa J, Miyayama S, Nakanuma Y, Matsui O. Immunoglobulin G4–related Periaortitis and Periarteritis: CT Findings in 17 Patients. Radiology 2011; 261:625-33. [DOI: 10.1148/radiol.11102250] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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34
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Abstract
PURPOSE OF REVIEW IgG4-related systemic disease is a recently proposed entity characterized by high serum IgG4 concentrations, sclerosing inflammation containing numerous IgG4-positive plasmacytes, dramatic responsiveness to steroid therapy, and occurrence of multiple organs. This review described that some cases of inflammatory abdominal aortic aneurysm (IAAA) have similar clinicopathological features that are now considered to represent aortic lesions of IgG4-related systemic disease under the concept of IgG4-related IAAA. RECENT FINDINGS IgG4-related IAAA is characterized by high serum IgG4 and immunoglobulin E levels, high titers of antinuclear antibodies, and high prevalence of allergic disorders such as bronchial asthma. The patients show a risk of developing IgG4-related systemic diseases in other organs during their life. Histologically, sclerosing inflammation containing numerous IgG4-positive plasmacytes is observed predominantly in the adventitia. Similar lesions have also been reported in the thoracic aorta and large arteries. SUMMARY Recognition of the fact that IgG4-related systemic disease could involve the vascular lesions offers potential new management of those. However, only 3 years have passed since the first report of IgG4-related IAAA. Further studies are necessary to elucidate other vascular lesions associated with IgG4-related systemic disease, the usefulness of steroid therapy for the management of IgG4-IAAA, and underlying pathological and immunological characteristics.
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35
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Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease. Curr Opin Rheumatol 2011; 23:88-94. [PMID: 21037477 DOI: 10.1097/bor.0b013e3283412f7c] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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36
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Current world literature. Curr Opin Rheumatol 2010; 23:125-30. [PMID: 21124095 DOI: 10.1097/bor.0b013e3283422cce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Kasashima S, Zen Y. IgG4-related Inflammatory Abdominal Aortic Aneurysm, Spectrum of IgG4-related Chronic Periaortitis. Ann Vasc Dis 2010; 3:182-9. [PMID: 23555408 DOI: 10.3400/avd.sasvp01002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2010] [Indexed: 12/24/2022] Open
Affiliation(s)
- Satomi Kasashima
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan ; Department of Clinical Laboratory, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
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38
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IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity. Adv Anat Pathol 2010; 17:303-32. [PMID: 20733352 DOI: 10.1097/pap.0b013e3181ee63ce] [Citation(s) in RCA: 291] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An elevated serum titer of immunoglobulin G4 (IgG4), the least common (3% to 6%) of the 4 subclasses of IgG, is a surrogate marker for the recently characterized IgG4-related sclerosing disease. The syndrome affects predominantly middle-aged and elderly patients, with male predominance. The patients present with symptoms referable to the involvement of 1 or more sites, usually in the form of mass lesions. The prototype is IgG4-related sclerosing pancreatitis (also known as autoimmune pancreatitis), most commonly presenting as painless obstructive jaundice with or without a pancreatic mass. Other common sites of involvement are the hepatobiliary tract, salivary gland, orbit, and lymph node, but practically any organ-site can be affected, such as retroperitoneum, aorta, mediastinum, soft tissue, skin, central nervous system, breast, kidney, prostate, upper aerodigestive tract, and lung. The patients usually have a good general condition, with no fever or constitutional symptoms. Common laboratory findings include raised serum globulin, IgG, IgG4, and IgE, whereas lactate dehydrogenase is usually not raised. Some patients have low titers of autoantibodies (such as antinuclear antibodies and rheumatoid factor). The disease often shows excellent response to steroid therapy. The natural history is characterized by the development of multiple sites of involvement with time, sometimes after many years. However, the disease can remain localized to 1 site in occasional patients. The main pathologic findings in various extranodal sites include lymphoplasmacytic infiltration, lymphoid follicle formation, sclerosis and obliterative phlebitis, accompanied by atrophy and loss of the specialized structures of the involved tissue (such as secretory acini in pancreas, salivary gland, or lacrimal gland). The relative predominance of the lymphoplasmacytic and sclerotic components results in 3 histologic patterns: pseudolymphomatous, mixed, and sclerosing. Immunostaining shows increased IgG4+ cells in the involved tissues (>50 per high-power field, with IgG4/IgG ratio >40%). The lymph nodes show multicentric Castleman disease-like features, reactive follicular hyperplasia, interfollicular expansion, or progressive transformation of germinal centers, with the unifying feature being an increase in IgG4+ plasma cells on immunostaining. The nature and pathogenesis of IgG4-related sclerosing disease are still elusive. Occasionally, the disease can be complicated by the development of malignant lymphoma and possibly carcinoma.
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