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Mikulicz's disease and Küttner's tumor as manifestations of IgG4-related diseases: a review of the literature. Reumatologia 2020; 58:243-250. [PMID: 32921832 PMCID: PMC7477471 DOI: 10.5114/reum.2020.98437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
According to a new concept for the classification and division of autoimmune diseases, Mikulicz's disease and Küttner's tumor belong to immunoglobulin G4-related diseases (IgG4-RD) and fulfil their diagnostic criteria. The aim of this study was to summarize the new classification concepts of IgG4-RD in the head and neck area and to review their clinical, histopathological and serologic criteria and the methods used in the diagnostic workup with respect to their advantages, limitations and differentiative value. The PubMed, Web of Science, Google Scholar, and Scopus databases were searched for articles published between 2009 and 2019 using the following key words: IgG4-related diseases, Mikulicz's disease, Küttner's tumor, salivary glands, xerostomia. Results of the review of the literature revealed that Mikulicz's disease and Küttner's tumor fulfil the same diagnostic criteria but may manifest different clinical symptoms which determine the choice of the different diagnostic tools.
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Hong X, Zhang YY, Li W, Liu YY, Wang Z, Chen Y, Gao Y, Sun ZP, Peng X, Su JZ, Cai ZG, Zhang L, He J, Ren LM, Yang HY, Li ZG, Yu GY. Treatment of immunoglobulin G4-related sialadenitis: outcomes of glucocorticoid therapy combined with steroid-sparing agents. Arthritis Res Ther 2018; 20:12. [PMID: 29382364 PMCID: PMC5791187 DOI: 10.1186/s13075-017-1507-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/28/2017] [Indexed: 12/24/2022] Open
Abstract
Background Immunoglobulin G4-related sialadenitis (IgG4-RS) is a newly recognized immune-mediated systemic disease. Despite its good response to steroid therapy, its treatment protocol is not standardized and the long-term outcome is controversial. The study was conducted to determine the short-term and long-term outcomes of IgG4-RS patients treated with glucocorticoids and steroid-sparing immunosuppressive agents, to analyze secretory function, serological and radiological changes in salivary glands and to assess the usefulness of serum IgG4 level as an indicator of disease activity. Methods IgG4-RS patients who were treated for more than 3 months were enrolled. Serological tests, salivary gland function assessment and computed tomography (CT) were performed before treatment and during follow up. The treatment outcomes in the short and the long term were evaluated, and the relationship between serum IgG4 level and salivary gland volume was analyzed. Results Glucocorticoids were used in all 43 patients and steroid-sparing immunosuppressive agents in 38 patients (88.4%). The follow-up period was 24.6 ± 14.9 months. Clinical remission was achieved in all patients after induction therapy. During short-term observation, salivary gland secretion significantly increased, and the serum IgG4 levels, the volumes and CT values of submandibular and parotid gland decreased significantly (P < 0.001). For long term, relapse occurred in 32.5% patients within 55 months in the regularly treated group, while all seven irregularly treated patients relapsed. However, the relapse-free survival curves were not significantly different between the steroid monotherapy and the combination therapy groups (P = 0.566). Submandibular glands, lacrimal glands, sublingual glands, nasal and paranasal cavity were commonly relapsing organs. In clinically stable patients, a serologically unstable condition occurred in 54.9% patients within 55 months and medication adjustment was performed accordingly. Volume changes in the submandibular and parotid glands were associated with serum IgG4 levels and time of follow up (R2adjusted = 0.905, P < 0.0001 and R2adjusted = 0.9334, P < 0.0001, respectively). Conclusions The combination of glucocorticoid and steroid-sparing agents could be effective for treating IgG4-RS, and restoring salivary gland function. Serum IgG4 levels could predict disease activity. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1507-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xia Hong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China.,Center for Stomatology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yan-Yan Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Wei Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Yan-Ying Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Zhen Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Yan Chen
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhi-Peng Sun
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Jia-Zeng Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Li-Min Ren
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Hong-Yu Yang
- Center for Stomatology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhan-Guo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Street, Beijing, 100081, China. .,Center for Stomatology, Peking University Shenzhen Hospital, Shenzhen, China.
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IgG4-Related Kidney Disease in a Patient With History of Breast Cancer: Findings on 18F-FDG PET/CT. Clin Nucl Med 2017; 41:e388-9. [PMID: 27187735 DOI: 10.1097/rlu.0000000000001252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 64-year-old African American woman with history of stage III breast carcinoma, 3 years after complete response to therapy, presents with progressive fatigue, increasing arthralgia, and unintentional weight loss of 15 lb in 3 months. An F-FDG PET demonstrated new diffuse FDG avidity of the renal parenchyma, new FDG-avid foci in pancreas and lungs, and new FDG-avid lymph nodes above and below the diaphragm. While a retroperitoneal lymph node biopsy was inconclusive, a kidney biopsy resulted in diagnosis of diffuse, severe, IgG4-related tubulointerstitial nephritis. Treatment with corticosteroid led to complete resolution of the symptoms and PET findings.
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Kuroda N, Nao T, Fukuhara H, Karashima T, Inoue K, Taniguchi Y, Takeuchi M, Zen Y, Sato Y, Notohara K, Yoshino T. IgG4-related renal disease: clinical and pathological characteristics. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:6379-6385. [PMID: 25337295 PMCID: PMC4203266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
IgG4-related disease is a recently established systemic condition. Tubulointerstitial nephritis is the most common renal manifestation. Glomerular lesions, particularly membranous glomerulonephritis, can develop simultaneously. Some patients present with serological renal dysfunction associated with elevated IgG or IgE levels and hypocomplementemia, while others are incidentally found to have abnormalities in kidneys on imaging. A majority of patients with IgG4-related kidney disease have similar lesions at other anatomical sites, which help us to suspect this condition. Serum IgG4 elevation (>135 mg/dL) is the most, although not entirely, specific marker for the diagnosis. Imaging findings varies from small nodules to bilateral diffuse abnormalities. In addition to the renal parenchyma, the renal pelvis and perirenal adipose tissue can be affected. Histological features include dense lymphoplasmacytic infiltration, storiform or "bird's eye" fibrosis (highlighted by PAM stain), and IgG4-positive plasma cell infiltration (>10 cells/high-power field and IgG4/IgG-positive cell ratio >40%). Immune complex deposition is detectable in the tubular basement membrane by immunofluorescence and/or electron microscopy. Patients usually respond well to corticosteroids, but highly active diseases may require other immunosuppressive therapies. Further investigations will be required to fully understand pathophysiology underlying this emerging condition.
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Affiliation(s)
- Naoto Kuroda
- Department of Diagnostic Pathology, Kochi Red Cross HospitalKochi, Japan
| | - Tomoya Nao
- Department of Urology, Metabolism and Nephrology, Kochi Medical School, Kochi UniversityKochi, Japan
| | - Hideo Fukuhara
- Department of Urology, Metabolism and Nephrology, Kochi Medical School, Kochi UniversityKochi, Japan
| | - Takashi Karashima
- Department of Urology, Metabolism and Nephrology, Kochi Medical School, Kochi UniversityKochi, Japan
| | - Keiji Inoue
- Department of Urology, Metabolism and Nephrology, Kochi Medical School, Kochi UniversityKochi, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi UniversityKochi, Japan
| | - Mai Takeuchi
- Department of Diagnostic Pathology, Kobe University Graduate School of MedicineKobe, Japan
| | - Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of MedicineKobe, Japan
| | - Yasuharu Sato
- Division of Pathophisiology, Okayama University Graduate School of Health SciencesOkayama, Japan
- Department of Pathology, Okayama Graduate School of Medicine, Density, Pharmaceutical SciencesOkayama, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central HospitalKurashiki, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama Graduate School of Medicine, Density, Pharmaceutical SciencesOkayama, Japan
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Ardalan MR, Nasri H. Anti-phospholipase A2 receptor antibody in idiopathic membranous nephropathy: New concepts. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2013; 18:459-61. [PMID: 24250691 PMCID: PMC3818612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mohammad-Reza Ardalan
- Department of Nephrology, Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Nasri
- Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Prof. Hamid Nasri, Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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