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Azzi L, Magnoli F, Krepysheva D, Fontana F, Coppola A, Cappelli A, Dani M, Battaglia P, Rabbiosi D. The "great imitator": IgG4-related disease of the oral cavity. Two case reports and scoping review. Head Neck 2024; 46:1510-1525. [PMID: 38566594 DOI: 10.1002/hed.27763] [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: 12/23/2023] [Revised: 02/24/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
This study aimed to review the lesser-known intraoral manifestations of immunoglobulin G4-related disease (IgG4-RD). In this paper we report an unprecedented case of oral IgG4-RD mimicking angiolymphoid hyperplasia with eosinophilia (ALHE), and another case presenting as plasma cell gingivitis. We then performed a scoping review of published cases of IgG4-RD involving the oral cavity. The following data were collected for each case: age, sex, intraoral site(s) involved, clinical appearance, imaging features, serum IgG4 values, histopathology, treatment, and follow-up duration. Fifty-one cases of oral IgG4-RD were published in literature. The hard palate and jaw bones were the two main locations reported, while the histological identification of a IgG4/IgG plasma cells ratio ≥40% was fundamental for diagnosis. Conversely, the pathological features of storiform fibrosis and obliterative phlebitis were not common. Future reports regarding oral IgG4-RD should report clear adherence to the recognized international diagnostic criteria of the disease.
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Affiliation(s)
- Lorenzo Azzi
- Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
- Unit of Oral Medicine and Pathology, Dental Clinic, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Francesca Magnoli
- Unit of Pathology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Diana Krepysheva
- Unit of Pathology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Federico Fontana
- Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
- Unit of Radiology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Andrea Coppola
- Unit of Radiology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Antonella Cappelli
- Unit of Rheumatology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - Marta Dani
- Unit of Oral Medicine and Pathology, Dental Clinic, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
- Unit of Otolaryngology and Head and Neck Surgery, Azienda Socio-Sanitaria Territoriale Lariana, San Fermo della Battaglia (CO), Italy
| | - Dimitri Rabbiosi
- Department of Biotechnology and Life Science, University of Insubria, Varese, Italy
- Unit of Maxillofacial Surgery, Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Varese, Italy
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Muniz VRVM, Altemani A, Freitas VS, Pires BC, de Santana DA, Couto LA, Cangussu MCT, Gomez RS, de Souza SCOM, Vargas PA, Cury PR, de Araújo IB, Chaves RRM, Fonseca FP, Dos Santos JN. Chronic Sclerosing Sialadenitis of the Submandibular Gland and its Histopathological Spectrum in the IgG4-Related Disease: a Series of 17 Cases. Head Neck Pathol 2024; 18:42. [PMID: 38735890 PMCID: PMC11089028 DOI: 10.1007/s12105-024-01651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE This study aimed to characterize the histopathological immunohistochemical features of chronic sclerosing sialadenitis, emphasizing the IgG4-related disease. METHODS Seventeen cases of chronic sclerosing sialoadenitis were examined for histopathological aspects, (inflammation, fibrosis, glandular parenchyma, and lymphoid follicles) and immunohistochemistry (BCL2, CD3, CD20, CD34, CD163, p63, cyclin D1, mast cell, SMA, S100A4, IgG, and IgG4) which were scored. IgG4-related disease features were investigated. Demographic and clinical data were also collected. RESULTS Males predominated (10:7), with an average lesion size of 3.9 cm. Common histopathological findings included reduced acinar parenchyma, lymphoid follicle formation, and ductular proliferation. CD3-positive T lymphocytes and CD34- and SMA-positive stromal fibroblasts were abundant. Nine cases (53%) showed sialoliths and three cases met the criteria for IgG4-related disease. CONCLUSION CSS of the submandibular gland represents a reactive pattern rather than IgG4-RD as only 3 cases seemed to be related to IgG4-RD. The immunohistochemical profile revealed an abundant population of CD3-positive T lymphocytes, as opposed to regulatory proteins such as cyclin D1, demonstrating that populations of CD34- and SMA-positive stromal fibroblasts contribute to the fibrosis characteristic of CSS. In addition, our results provide a comprehensive insight into the study of CSS and its relationship with IgG4-RD.
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Affiliation(s)
| | - Albina Altemani
- Department of Pathology, School of Medical Sciences, State University of Campinas, Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Valéria Souza Freitas
- Department of Health, School of Dentistry, State University of Feira de Santana (UEFS), Feira de Santana, Feira de Santana, Bahia, Brazil
| | | | - Dandara Andrade de Santana
- Department of Biological Sciences, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Larissa Abbehusen Couto
- Department of Biological Sciences, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | | | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Pablo Augustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Patrícia Ramos Cury
- Department of Biological Sciences, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Iguaracyra Barreto de Araújo
- Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Roberta Rayra Martins Chaves
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Jean Nunes Dos Santos
- Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
- Faculdade de Odontologia - UFBA, Laboratório de Patologia Oral e Maxilofacial, Avenida Araújo Pinho, 62, Canela, Salvador, 40110-150, Bahia, Brazil.
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Li ZZ, Zhu H, Li W, Gao Y, Su JZ, Yu GY. Utility of navigation system-guided submandibular gland core needle biopsy in the diagnosis of immunoglobulin G4-related sialadenitis. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00008-5. [PMID: 36682914 DOI: 10.1016/j.ijom.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/07/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
Pathological diagnosis is important for the definite diagnosis of immunoglobulin G4-related sialadenitis (IgG4-RS). Core needle biopsy (CNB) is a scarless technique; however the pathological heterogeneity of IgG4-RS (a particular feature of this disease) could be the potential cause of the inferior diagnostic capability of submandibular gland CNB (SMG-CNB) for IgG4-RS. The aim of this study was to explore technical improvements in SMG-CNB and improve its diagnostic power in IgG4-RS diagnosis. Eighteen patients clinically suspected for IgG4-RS were enrolled and underwent both SMG-CNB and SMG surgical biopsy. A navigation system (Brainlab) was employed during SMG-CNB to obtain representative samples and avoid blood vessel injury. Histopathological and immunopathological findings for the SMG-CNB samples were in good concordance with SMG surgical biopsy. There was no statistically significant difference between SMG-CNB and SMG surgical biopsy in IgG-positive cell count (132.4 ± 59.3 vs 132.2 ± 47.5, P = 0.99), IgG4-positive cell count (102.2 ± 39.7 vs 97.2 ± 27.6, P = 0.67), or IgG4-positive/IgG-positive cell count ratio (78.6% ± 0.1% vs 75.2% ± 0.1%, P = 0.29). A moderate or strong significant correlation was found between SMG-CNB and SMG surgical biopsy for these cell counts and ratio (all P < 0.01). The diagnostic consistency of SMG-CNB and SMG surgical biopsy was 100%. The Brainlab navigation system may assist in collecting representative SMG-CNB samples from typical pathological lesions. Tissues obtained from SMG-CNB are sufficient for the pathological diagnosis of IgG4-RS. Standardized SMG-CNB is expected to replace SMG surgical biopsy for IgG4-RS diagnosis.
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Affiliation(s)
- Z-Z Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - H Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - W Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Y Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - J-Z Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Pereira GG, Pontes FSC, Soares CD, de Carvalho MGF, da Silva TA, Calderaro DC, Ferreira GA, Tanure LA, de Souza LL, Rodrigues-Fernandes CI, de Almeida OP, Fonseca FP, Pontes HAR. Oral and maxillofacial manifestations of IgG4-related disease: A clinicopathological study. J Oral Pathol Med 2022; 51:493-500. [PMID: 35347770 DOI: 10.1111/jop.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/04/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND IgG4-related disease is a fibroinflammatory and immune-mediated condition, which has extremely variable clinical manifestations. In this study, we aim to investigate the clinicopathological features of IgG4-related disease involving the oral and maxillofacial region. METHODS Cases of IgG4-related disease manifesting in the oral and maxillofacial region were retrieved from three Brazilian institutions. Clinical and serological data were obtained from the patients' medical charts, while microscopic and immunohistochemical findings were revised by oral pathologists. Diagnosis followed the American College of Rheumatology/European League against Rheumatism criteria. RESULTS Seven patients diagnosed with IgG4-related disease were included in this study. Women were affected in all analysed cases, with a mean age of 55.4 years. Two patients presented with the clinical involvement of more than one oral and maxillofacial anatomic site. Therefore, our sample comprised nine oral and maxillofacial anatomic sites affected by IgG4-related disease. The submandibular gland was affected in four cases, the tongue and the parotid gland in two cases each, and the palate in one case. In a few cases, exploratory lower lip biopsy was used as a diagnostic approach. A moderate-to-severe lymphoid infiltrate containing plasma cells and lymphocytes, with an increased IgG4/IgG ratio, was common. Treatment varied and steroids were the most frequently used (57.4%). Six patients remained alive, while one died from unknown causes. CONCLUSION Although major salivary glands are commonly affected by IgG4-related disease, the oral cavity can also be involved, and lower lip biopsy may be an auxiliary diagnostic tool.
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Affiliation(s)
- Glauce Guimarães Pereira
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Flávia Sirotheau Corrêa Pontes
- Service of Surgery and Oral Pathology, João de Barros Barreto University Hospital, Universidade Federal do Pará, Belém, Brazil
| | | | | | | | - Débora Cerqueira Calderaro
- Rheumatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gilda Aparecida Ferreira
- Rheumatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leandro Augusto Tanure
- Rheumatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Lacerda de Souza
- Service of Surgery and Oral Pathology, João de Barros Barreto University Hospital, Universidade Federal do Pará, Belém, Brazil.,Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hélder Antônio Rebelo Pontes
- Service of Surgery and Oral Pathology, João de Barros Barreto University Hospital, Universidade Federal do Pará, Belém, Brazil.,Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Liu Y, Yang F, Chi X, Zhang Y, Fu J, Bian W, Shen D, Li Z. Needle biopsy compared with surgical biopsy: pitfalls of small biopsy in histologial diagnosis of IgG4-related disease. Arthritis Res Ther 2021; 23:54. [PMID: 33568210 PMCID: PMC7874654 DOI: 10.1186/s13075-021-02432-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The growing utilization of needle biopsy has challenged the current pathology consensus of IgG4-related disease (IgG4-RD). The aims of this study were to identify the histological characteristics of needle biopsy and surgical specimens and evaluate the ability of needle biopsy in histological diagnosis of IgG4-RD. Methods Biopsies from patients who were referred to as IgG4-RD by the 2019 ACR/EULAR IgG4-RD classification criteria in Peking University People’s Hospital from 2012 to 2019 were re-evaluated. Typical histological features and diagnostic categories were compared between needle biopsy and surgical biopsy. Results In total, 69 patients met the 2019 ACR/EULAR classification criteria and 72 biopsies of them were re-evaluated. All cases showed lymphoplasmacytic infiltrate, while storiform fibrosis and obliterative phlebitis were only present in 35 (48.6%) and 23 (31.9%) specimens, respectively. Storiform fibrosis was more likely to be seen in retroperitoneum lesion (P = 0.033). Surgical biopsy showed significantly higher IgG4+ plasma cells/high-power field (IgG4/HPF) count (P < 0.01) and higher proportion of IgG4/HPF > 10 (P < 0.01). No significant difference was observed with regard to the ratio of IgG4+ plasma cells/IgG+ plasma cells (IgG4/IgG) (P = 0.399), storiform fibrosis (P = 0.739), and obliterative phletibis (P = 0.153). According to the 2011 comprehensive diagnostic criteria, patients who performed a needle biopsy were less likely to be probable IgG4-RD (P = 0.045). Based on the 2011 pathology consensus, needle biopsy was less likely to be diagnosed as IgG4-RD (P < 0.01), especially to be highly suggestive IgG4-RD (P < 0.01). Only 1/18 (5.6%) needle salivary specimens fulfilled the cutoff of IgG4/HPF > 100, which was significantly less than 15/23 (65.2%) of surgical ones (P < 0.01). Conclusions Needle biopsy shows an inferiority in detecting IgG4/HPF count but not in IgG4/IgG ratio, storiform fibrosis, and obliterative phlebitis. Compared with surgical samples, needle biopsy is less likely to obtain a histological diagnosis of IgG4-RD. A different IgG4/HPF threshold for needle biopsy of the salivary glands may be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02432-y.
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Affiliation(s)
- Yanying Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China.
| | - Fei Yang
- Department of Pathology, Peking University People's Hospital, Beijing, 100044, China
| | - Xiying Chi
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
| | - Yuxin Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
| | - Jiangnan Fu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
| | - Wenjie Bian
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing, 100044, China.
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China.
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6
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Zhang YY, Hong X, Wang Z, Li W, Su JZ, Chen Y, Gao Y, Yu GY. Diagnostic utility of submandibular and labial salivary gland biopsy in IgG4-related sialadenitis. Clin Rheumatol 2020; 39:3715-3721. [PMID: 32458243 DOI: 10.1007/s10067-020-05097-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The diagnostic utility of labial salivary gland (LSG) biopsy for IgG4-related sialadenitis remains undetermined. The purpose of the present study was to determine whether submandibular gland biopsy could be replaced by LSG biopsy for diagnosing IgG4-RS. PATIENTS AND METHODS Medical records of two groups of patients were reviewed. Group A contained 45 patients suspected to have IgG4-RS who underwent both SMG and LSG biopsies. Group B contained 25 patients who were clinically and pathologically diagnosed with Sjögren syndrome (SS). Biopsy samples were stained using hematoxylin and eosin (HE) and immunohistochemical techniques and observed under an optical microscope. Relevant data describing histopathological characteristics were collected and analyzed. RESULTS SMG of IgG4-RS patients presented typical histopathological characteristics of fibrosis and IgG4-positive plasmacytic infiltration, while LSG showed varied characteristics. The sensitivity and accuracy of SMG for diagnosing IgG4-RS were greater than those of LSG (100% and 100% versus 55.3% and 75.7%, respectively, P < 0.05). CONCLUSIONS Biopsy of SMG showed greater sensitivity and specificity, whereas LSG biopsy showed varied histopathological and immunohistochemical characteristics; thus, SMG biopsy cannot be replaced by LSG biopsy for diagnosis of IgG4-RS.
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Affiliation(s)
- Yan-Yan Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xia Hong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhen Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wei Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jia-Zeng Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 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
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China. .,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.
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Peuraharju E, Saarinen R, Aro K, Mäkinen LK, Tarkkanen J, Mäkitie A, Haglund C, Hagström J, Atula T. Sclerosing sialadenitis of the submandibular gland is rarely an immunoglobulin G4-related disease in the Finnish population. Mod Pathol 2020; 33:551-559. [PMID: 31680120 DOI: 10.1038/s41379-019-0395-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Abstract
Chronic sclerosing sialadenitis may represent one of many manifestations of an immunoglobulin G4-related disease. However, existing studies typically consist of small patient cohorts rarely conducted in Western populations. The clinical behavior of chronic sclerosing sialadenitis, including follow-up data, warrants further study. Thus, we aimed to determine whether chronic sclerosing sialadenitis always presents as IgG4-related disease or associates with autoimmune diseases and to determine which additional examinations patients may require. Between 2000 and 2017, 51 patients undergoing submandibular gland resection within the Helsinki University Hospital area were diagnosed with chronic sclerosing sialadenitis. We re-evaluated all specimens and performed immunostaining for IgG4. IgG and CD31 stainings were performed for IgG4-positive specimens. IgG4-related disease diagnosis was defined by the Boston consensus statement criteria. We revised clinical data, distributing a follow-up questionnaire to patients to register symptoms of IgG4-related disease or autoimmune disease during follow-up. The chronic sclerosing sialadenitis criteria were fulfilled in 34 patients, whereby 17 were diagnosed as non-sclerosing chronic sialadenitis. In 19 cases, a sialolith associated with a salivary gland lesion. In total, 12 of 51 cases were recognized as IgG4-positive, while two met the criteria for IgG4-related disease. These two cases belonged to the non-sclerosing chronic sialadenitis group, and both involved other organs. The histopathological features between chronic sclerosing sialadenitis and non-sclerosing chronic sialadenitis overlapped regarding the degree of fibrosis and inflammatory infiltrates. In the Finnish population, chronic sclerosing sialadenitis of the submandibular gland does not appear to present as IgG4-related disease. Non-sclerosing chronic sialadenitis can associate with IgG4-related disease. A histopathological distinction between chronic sclerosing sialadenitis and non-sclerosing chronic sialadenitis is not always unequivocal and the presence of a sialolith does not exclude IgG4-positivity. Therefore, immunostaining for IgG4 should be performed when dense plasma cell infiltration is present in either non-sclerosing chronic sialadenitis or chronic sclerosing sialadenitis.
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Affiliation(s)
- Elin Peuraharju
- Department of Oral and Maxillofacial Diseases, University of Helsinki, PO Box 41, FI-00014, Helsinki, Finland.
| | - Riitta Saarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
| | - Laura K Mäkinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki, HUSLAB and Helsinki University Hospital, PO Box 21, FI-00014, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Caj Haglund
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, PO Box 22, FI-00014, Helsinki, Finland.,Department of Surgery, University of Helsinki and Helsinki University Hospital, PO Box 20, FI-00014, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki, HUSLAB and Helsinki University Hospital, PO Box 21, FI-00014, Helsinki, Finland.,Research Programs Unit, Translational Cancer Medicine, University of Helsinki, PO Box 22, FI-00014, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
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8
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Konno T, Takano K, Kaneko Y, Kakuki T, Nomura K, Yajima R, Kakiuchi A, Kohno T, Himi T, Kojima T. Guanylate binding protein-1-mediated epithelial barrier in human salivary gland duct epithelium. Exp Cell Res 2018; 371:31-41. [PMID: 30044945 DOI: 10.1016/j.yexcr.2018.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 02/07/2023]
Abstract
Guanylate-binding protein-1 (GBP-1) is an interferon-inducible large GTPase involved in the epithelial barrier at tight junctions. To investigate the role of GBP-1 in the epithelial barrier, primary human salivary gland duct epithelial cells were treated with the the proinflammatory cytokines IFNγ, IL-1β, TNFα and the growth factor TGF-β. Treatment with IFNγ, IL-1β, or TNFα markedly enhanced GBP-1 and the epithelial barrier function, and induced not only CLDN-7 but also the tricellular tight junction molecule lipolysis-stimulated lipoprotein receptor (LSR). Knockdown of GBP-1 by its siRNA induced endocytosis of tight junction molecules, and prevented the increases of CLDN-7 and LSR with the upregulation of the epithelial barrier function induced by treatment with IFNγ or TNFα. Treatment with a PKCα inhibitor induced expression of GBP-1, CLDN-7 and LSR and enhanced the epithelial barrier function. In almost intact salivary gland ducts from patients with IgG4-related disease (IgG4-RD) indicated significant infiltration of IgG-positive plasma cells, expression of GBP-1, CLDN-7 and LSR was increased. These findings indicated that GBP-1 might play a crucial role in barrier function of normal human salivary gland duct epithelium and perform a preventive role in the duct epithelium of IgG4-RD disease.
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Affiliation(s)
- Takumi Konno
- Department of Cell Science, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Kenichi Takano
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Yakuto Kaneko
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Takuya Kakuki
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Kazuaki Nomura
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Ryoto Yajima
- Department of Cell Science, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Akito Kakiuchi
- Department of Cell Science, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Takayuki Kohno
- Department of Cell Science, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Tetsuo Himi
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Takashi Kojima
- Department of Cell Science, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan.
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Salivary Gland Pathology in IgG4-Related Disease: A Comprehensive Review. J Immunol Res 2018; 2018:6936727. [PMID: 29805984 PMCID: PMC5901485 DOI: 10.1155/2018/6936727] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/05/2018] [Indexed: 02/07/2023] Open
Abstract
IgG4-related disease (IgG4-RD) is a rare fibroinflammatory condition that can affect almost any organ, characterized by swollen lesions and often by eosinophilia and elevated serum IgG4 concentrations. The diagnosis of IgG4-RD is a challenging task: in fact, single or multiple organs can be affected and clinical, serological, and histological findings can be heterogeneous. In IgG4-RD, the involvement of salivary glands is observed in 27% to 53% of patients. Several organ-specific conditions, now recognized as different manifestations of IgG4-related sialadenitis (IgG4-RS), were viewed in the past as individual disease entities. The study of salivary glands may sometimes be complex, because of the number of pathological conditions that may affect them, often with overlapping clinical pictures. Integration of different imaging techniques is often required in the case of swelling of salivary glands, even though biopsy remains the gold standard for a definite diagnosis of IgG4-RS. Thus, in this review, we discuss new insights in the pathogenesis of IgG4-RD, focusing on its clinical aspects and the tools that are currently available for a correct differential diagnosis when the salivary glands are involved.
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Recent advances in knowledge regarding the head and neck manifestations of IgG4-related disease. Auris Nasus Larynx 2016; 44:7-17. [PMID: 27956101 DOI: 10.1016/j.anl.2016.10.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/31/2016] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a chronic inflammatory disorder, characterized by elevated serum IgG4 levels as well as abundant infiltration of IgG4-positive plasmacytes and fibrosis in various organs, including the head and neck region. In particular, the salivary glands, orbit, and thyroid are common sites of disease involvement. IgG4-RD is diagnosed based on various clinical, serological, and histopathological findings, none of which are pathognomonic. Hence, various differential diagnoses, which exhibit elevated serum IgG4 levels and infiltration of IgG4-postive cells into tissues, need to be excluded, especially malignant diseases and mimicking disorders. Systemic corticosteroids are generally effective in inducing IgG4-RD remission; however, recurrent or refractory cases are common. In addition, although the pathogenic mechanisms of IgG4-RD remain unclear, an antigen-driven inflammatory condition is believed to be involved. Recent studies have indicated the important pathogenic role of B cell/T cell collaboration and innate immunity in this disease. Nevertheless, additional research and discussions are needed to resolve many remaining questions. In this review, we provide an overview of the recent insights on the history, clinical features, diagnosis, and treatment of IgG4-RD in the head and neck region. Furthermore, we have also addressed the pathogenesis of this disease.
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Takano K, Yamamoto M, Ichimiya S, Takahashi H, Himi T. Assessing the usefulness of salivary gland biopsy for diagnosis of type-1 autoimmune pancreatitis. Mod Rheumatol 2016; 27:548-550. [PMID: 27426059 DOI: 10.1080/14397595.2016.1209818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kenichi Takano
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Motohisa Yamamoto
- b Department of the Gastroenterology , Rheumatology and Clinical Immunology
| | - Shingo Ichimiya
- c Department of Human Immunology , Research Institute for Frontier Medicine , and.,d Department of Surgical Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Hiroki Takahashi
- b Department of the Gastroenterology , Rheumatology and Clinical Immunology
| | - Tetsuo Himi
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
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Takano K, Nomura K, Abe A, Kamekura R, Yamamoto M, Ichimiya S, Takahashi H, Himi T. Clinicopathological analysis of salivary gland tissue from patients with IgG4-related disease. Acta Otolaryngol 2016; 136:717-21. [PMID: 27007955 DOI: 10.3109/00016489.2016.1154605] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Conclusion The diagnosis of immunoglobulin G4-related disease (IgG4-RD) should be based on the morphology of tissue biopsy, and this study recommends a submandibular gland (SMG) biopsy for accurate diagnosis and to exclude malignant disease. Objective To clarify which type of biopsy specimen (SMG or labial salivary gland [LSG]) should be taken from patients with IgG4-RD. Methods This study included 33 patients with IgG4-RD (21 women; 12 men) who were subjected to both SMG and LSG biopsies at Sapporo Medical University between 2011-2015. Tissues obtained from the SMG and LSG specimens were evaluated. Results All SMG specimens satisfied the diagnostic criteria for IgG4-RD, whereas 19 (57.6%) LSG specimens satisfied the diagnostic criteria for IgG4-RD. Histological evaluation showed fibrosis in all the SMG specimens and in eight LSG specimens (24.2%). Obliterative phlebitis was seen in nine SMG specimens (27.3%), but it was absent in all the LSG specimens.
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Affiliation(s)
- Kenichi Takano
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Kazuaki Nomura
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Ayumi Abe
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Ryuta Kamekura
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
- b Department of Human Immunology , Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Motohisa Yamamoto
- c Division of Rheumatology and Clinical Immunology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Shingo Ichimiya
- b Department of Human Immunology , Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine , Sapporo , Japan
- d Department of Surgical Pathology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Hiroki Takahashi
- c Division of Rheumatology and Clinical Immunology , Sapporo Medical University School of Medicine , Sapporo , Japan
| | - Tetsuo Himi
- a Department of Otolaryngology , Sapporo Medical University School of Medicine , Sapporo , Japan
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Stone JH, Brito-Zerón P, Bosch X, Ramos-Casals M. Diagnostic Approach to the Complexity of IgG4-Related Disease. Mayo Clin Proc 2015; 90:927-39. [PMID: 26141331 DOI: 10.1016/j.mayocp.2015.03.020] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a systemic disease characterized by the infiltration of IgG4-bearing plasma cells and, more importantly, distinctive histopathological features: storiform fibrosis, obliterative phlebitis, a lymphoplasmacytic infiltrate, and mild-to-moderate tissue eosinophilia. The diagnostic approach is complex and relies on the coexistence of various clinical, laboratory, and histopathological findings, none of which is pathognomonic in and of itself. IgG4-related disease should be suspected in patients presenting with unexplained enlargement or swelling of 1 or more organs or tissue organs. Four laboratory abnormalities often provide initial clues to the diagnosis of IgG4-RD: peripheral eosinophilia, hypergammaglobulinemia, elevated serum IgE levels, and hypocomplementemia. Elevated serum IgG4 levels provided critical information in identifying the first cases of IgG4-RD, but recent studies have reported substantial limitations to the measurement of serum IgG4 concentrations, precluding reliance on serum IgG4 concentrations for diagnostic purposes. In contrast, new studies have suggested a promising role of flow cytometry studies in the diagnosis and longitudinal management of IgG4-RD. Demonstration of the classic histopathological features of IgG4-RD remains crucial to diagnosis in most cases, and biopsy proof is preferred strongly by most disease experts before the initiation of treatment. Of note, the multiorgan nature of IgG4-RD was first established in 2003. This review intends to provide most recent knowledge about the clinical, laboratory, radiological, and pathological characteristics of IgG4-RD that may guide the physician to establish an early diagnosis. We searched PubMed and MEDLINE for relevant articles published between January 1, 2000, and November 1, 2014, using the search terms IgG4 and IgG4-related.
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Affiliation(s)
- John H Stone
- Harvard Medical School, Boston, MA; Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA.
| | - Pilar Brito-Zerón
- Josep Font Laboratory of Autoimmune Diseases, CELLEX-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Spain
| | - Xavier Bosch
- Department of Internal Medicine (ICMiD), Hospital Clínic, University of Barcelona, Spain
| | - Manuel Ramos-Casals
- Josep Font Laboratory of Autoimmune Diseases, CELLEX-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Spain
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Abstract
IgG4-related disease (IgG4-RD) is an emerging immune-mediated disease with the capability of involving essentially any organ. The epidemiology of this disease has not been explored in detail. A majority of patients reported in the literature to date are from Japan, but the condition has been described all across the world and there is no strong evidence to suggest a predilection for Asian populations. The mean age at diagnosis is approximately 60 years and there is a decided male predominance for many clinical features, with an overall male:female ratio of 8:3. A cardinal feature of IgG4-RD is single or multiple organ swelling that often raises concern for malignancy. IgG4-RD should be suspected in patients presenting with unexplained enlargement or swelling of one or more organs. Presenting features vary substantially according to the specialty to which patients present first; in addition, the disease can be diagnosed unexpectedly in pathological specimens or identified incidentally on radiology studies. Involvement of major organs is common and IgG4-RD may lead to organ failure, particularly in the pancreas, liver and biliary tree, kidneys, thyroid gland, lungs, and aorta. The diagnosis of IgG4-RD relies on the coexistence of various clinical, laboratory and histopathological findings, although none is pathognomonic by itself.
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