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Neralla M, Satheesh T, Murugan MS. A Rare Presentation of Isolated IgG4-RD in the Oral Cavity Mimicking Oral Cancer: A Case Report. J Maxillofac Oral Surg 2024; 23:984-989. [PMID: 39118936 PMCID: PMC11303350 DOI: 10.1007/s12663-023-02018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/11/2023] [Indexed: 08/10/2024] Open
Affiliation(s)
- Mahathi Neralla
- Department of Oral and Maxillofacial SuregrySaveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, 600077 India
| | - Tharini Satheesh
- Department of Oral and Maxillofacial SuregrySaveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, 600077 India
| | - M. Senthil Murugan
- Department of Oral and Maxillofacial SuregrySaveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, 600077 India
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Khaladkar SM, Pandey A, Julakanti S, Paidlewar S, Sharma O. IgG4-Related Disease of Mastoid Presenting as Headache: A Case Report. Cureus 2024; 16:e65583. [PMID: 39192911 PMCID: PMC11349239 DOI: 10.7759/cureus.65583] [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: 06/19/2024] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
IgG4-related disease (IgG4-RD) is a complex multi-system inflammatory disorder that can affect various organs in the body. This condition is characterized by elevated levels of immunoglobulin G subclass 4 (IgG4) and the presence of specific histopathological features. While neurological involvement is not as common as in other organs, when it occurs, it can lead to hypertrophic pachymeningitis and hypophysitis. Here, we present a case of a 53-year-old male with right-sided hemicranial headache and diplopia. Computed tomography revealed a soft tissue density lesion in the middle ear cavity and mastoid antrum with the destruction of the mastoid septae. Magnetic resonance imaging revealed a lesion in the right middle ear cavity associated with pachymeningitis and right sigmoid and transverse sinus thrombosis. Tissue pathology revealed dense plasma cell-rich chronic inflammation with storiform fibrosis. Immunohistochemistry was positive for IgG4. Hence, a diagnosis of IgG4-related disease causing mastoiditis, pachymeningitis and cerebral venous thrombosis was made. The patient was successfully operated and treated with steroids. IgG4-RD remains a rare but serious condition. It is crucial to identify and treat this condition promptly as it can lead to permanent organ damage. When patients continue to experience middle ear symptoms after an infection has been treated and cancer has been ruled out, it is important to consider inflammatory conditions as a differential diagnosis.
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Affiliation(s)
- Sanjay M Khaladkar
- Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ankita Pandey
- Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sravya Julakanti
- Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sayali Paidlewar
- Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ojasvi Sharma
- Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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Wang N, Zhu P, Xiang Y, Tao L, Huang T, Feng Z. IgG4-related autoimmune pancreatitis and sclerosing cholangitis: A case report and literature review. Medicine (Baltimore) 2024; 103:e37922. [PMID: 38669380 PMCID: PMC11049740 DOI: 10.1097/md.0000000000037922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Immunoglobulin G4-related disease (IgG4-RD) can involve various organs throughout the body, primarily manifesting as endocrine dysfunction, visual impairment, jaundice, and limited sexual function. IgG4-related autoimmune pancreatitis is triggered by autoimmune reactions and characterized by structural changes in the pancreas and pancreatic ducts. The disease mainly affects middle-aged and elderly males, typically presenting as progressive painless jaundice and misdiagnosed as cholangiocarcinoma or pancreatic cancer. PATIENT CONCERNS This study reports a 54-year-old male who consulted with different institutions multiple times due to diabetes, pancreatitis, elevated liver enzymes, and jaundice. DIAGNOSES Magnetic resonance imaging revealed swollen head of the pancreas and atrophic tail. Liver and pancreatic tissue pathology showed IgG4 plasma cell infiltration, while liver biopsy indicated interface hepatitis, liver fibrosis, and pseudolobule formation, with no evidence of bile duct damage. INTERVENTIONS Following hormone therapy, the patient's serum IgG4 levels and liver enzyme levels returned to normal. OUTCOMES The disease relapsed 2 years after maintaining hormone therapy, and the patient underwent additional hormone-induced remission therapy combined with azathioprine. LESSONS The purpose of this research report is to enhance the awareness and understanding of IgG4-RD, emphasizing the necessity for personalized treatment strategies that take into account its recurrence, associations, and imaging features. This report provides valuable insights and guidance for clinicians in managing and diagnosing patients with IgG4-RD.
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Affiliation(s)
- Nanping Wang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Peng Zhu
- Department of Hepatobiliary Surgery, Fifth People’s Hospital, Nanchong City, Sichuan Province, China
| | - Yue Xiang
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Liping Tao
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Tao Huang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Zhisong Feng
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
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Assarzadegan N, Montgomery E. Uncommon Benign Neoplasms and Pseudotumors of the Liver. Arch Pathol Lab Med 2023; 147:390-402. [PMID: 35609332 PMCID: PMC10443935 DOI: 10.5858/arpa.2021-0539-ra] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The most common benign hepatic mass-forming lesions often display fairly specific imaging characteristics, whereas less familiar, rarer benign neoplasms and pseudotumors may pose a diagnostic challenge in clinical, radiology, and pathology practice because of either their rarity or their unusual features. OBJECTIVE.— To review a selection of pseudotumors and unusual benign hepatic neoplasms encountered in consultation practices with a focus on nonepithelial tumors. DATA SOURCES.— Sources include English-language literature and personal experiences. CONCLUSIONS.— Several benign conditions (namely, segmental atrophy, infections, immunoglobulin G4 [IgG4]-related sclerosing disease, angiomyolipoma, mesenchymal hamartoma, and various vascular lesions) can lead to formation of hepatic masses. Because of their rarity and underrecognition, such lesions are often diagnostically challenging. Awareness of hepatic pseudotumors and various rare hepatic neoplasms and their potential mimics can forestall misdiagnosis and inappropriate management.
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Affiliation(s)
- Naziheh Assarzadegan
- From the Department of Pathology, University of Michigan, Ann Arbor (Assarzadegan); and the Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida (Montgomery)
| | - Elizabeth Montgomery
- From the Department of Pathology, University of Michigan, Ann Arbor (Assarzadegan); and the Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida (Montgomery)
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Huynh KN, Kong MJ, Nguyen BD. Anatomic and Functional Imaging of Immunoglobulin G4-related Disease and Its Mimics. Radiographics 2023; 43:e220097. [PMID: 36821510 DOI: 10.1148/rg.220097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated fibrosclerosing disease with tumefactive lesions infiltrated by IgG4-positive plasma cells. Initially described as autoimmune pancreatitis, IgG4-RD is now recognized as a discrete entity and is found to affect virtually any organ in the body. Common extrapancreatic sites include the biliary tree, salivary glands, periorbital tissue, lungs, kidneys, lymph nodes, aorta, retroperitoneum, and thyroid gland. Diagnosis-which relies on histopathologic, serologic, and radiologic features-can be challenging with the disease underdiagnosed, as IgG4-RD often mimics malignancy, infectious processes, or other immune-mediated conditions. Patients may present with signs of compression of nearby structures due to mass effect or with organ failure when the disease is left untreated. The clinical course is complex, with single- or multiorgan involvement and metachronous or synchronous occurrence of lesions. IgG4-RD responds well to glucocorticoid therapy, disease-modifying antirheumatic drugs, and B-cell-depleting biologic agents; prompt diagnosis is important to avoid delay in treatment and unnecessary pharmacologic or surgical intervention. While imaging features may not be specific for IgG4-RD, functional whole-body imaging with fluorine 18-fluorodeoxyglucose PET/CT is a useful adjunct for localizing extrapancreatic sites for biopsy, monitoring therapeutic response, and demonstrating disease relapse. The authors describe the pancreatic and extrapancreatic sites of involvement in IgG4-RD, with imaging features and patterns to aid in distinguishing IgG4-RD from its mimics through a multimodality approach with emphasis on functional imaging evaluation. ©RSNA, 2023 Quiz questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Kenneth N Huynh
- From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (K.N.H.); and Department of Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.J.K., B.D.N.)
| | - Min J Kong
- From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (K.N.H.); and Department of Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.J.K., B.D.N.)
| | - Ba D Nguyen
- From the Department of Radiological Sciences, University of California-Irvine, Orange, Calif (K.N.H.); and Department of Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.J.K., B.D.N.)
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T Cell Roles and Activity in Chronic Sclerosing Sialadenitis as IgG4-Related Disease: Current Concepts in Immunopathogenesis. Autoimmune Dis 2022; 2022:5689883. [PMID: 35769404 PMCID: PMC9236833 DOI: 10.1155/2022/5689883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
IgG4-related disease is a multiorgan immunological fibroinflammatory disorder characterized by lymphoplasmacytic infiltration and fibrosis in multiple organs accompanied by high serum IgG4 levels. The salivary glands are the most common organs involved in this disease. Recently, chronic sclerosing sialadenitis affecting salivary glands, formerly known as Küttner's tumor, and Mikulicz's disease have been classified as a class of IgG4-related diseases. The etiopathobiology of IgG4-related disease is not fully understood. It has recently been hypothesized that the inflammatory and fibrotic process and the increased serum IgG4+ levels in IgG4-related disease are the result of an interaction between B cells and T helper cells, suggesting that T cells may play a key role in the pathogenesis of this disease. The aim of this review is to discuss the proposed roles of different T cell subsets in the pathogenesis of IgG4-related disease focusing on their roles in immunopathogenesis of IgG4-related sialadenitis.
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Jang SY, Han YS, Lee SY, Han JR, Kweon YO, Tak WY, Park SY, Lee YR, Ryeom HK, Cha JG, Hong J, Kang YN. A Case of Hepatic Immunoglobulin G4-Related Disease Presenting as an Inflammatory Pseudotumor and Sclerosing Cholangitis. Diagnostics (Basel) 2022; 12:diagnostics12061497. [PMID: 35741307 PMCID: PMC9222153 DOI: 10.3390/diagnostics12061497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
An inflammatory pseudotumor is a benign disease characterized by tumor-like lesions consisting of inflammatory cells including plasma cells and fibrous tissue. Recently, some inflammatory pseudotumor cases proved to be a form of Immunoglobulin G4-related disease (IgG4-RD). This novel clinical entity, recognized as a fibroinflammatory condition, is characterized by lymphoplasmacytic infiltration with a predominance of IgG4-positive plasma cells, storiform fibrosis, and often elevated serum IgG4 concentrations. We report a case of IgG4-RD in the form of an inflammatory pseudotumor in the liver with combined sclerosing cholangitis. We recommend that for diagnosing IgG4-RD accurately, it is important to obtain adequate tissue samples and follow-up the lesion in clinical practice.
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Affiliation(s)
- Se Young Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Young Seok Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (Y.S.H.); (J.R.H.)
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Ja Ryung Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (Y.S.H.); (J.R.H.)
| | - Young Oh Kweon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Yoo Na Kang
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-420-4887; Fax: +82-53-422-9195
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8
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Andron AA, Nair AG, Della Rocca D, Della Rocca RC, Reddy HS. Concomitant adult onset xanthogranuloma and IgG4-related orbital disease: a rare occurrence. Orbit 2022; 41:108-111. [PMID: 32847452 DOI: 10.1080/01676830.2020.1814353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Adult onset xanthogranulomatous disease is a rare orbital disease. IgG4-related disease is a systemic disease that can often manifest in the orbit. In this communication, we present the case of a patient with a xanthelasma-like lesion on the upper eyelid, and an enlarged lacrimal gland, which on biopsy was diagnosed as an orbital xanthogranuloma. Detailed serological workup showed that the patient was found to have elevated serum IgG4 levels. The orbital specimen was re-stained and found to be positive for IgG4. The patient was treated with oral steroids with partial resolution of the lesion. This is an interesting case of both histopathological adult onset xanthogranuloma (AOX) and IgG4-related orbital disease (IgG4-ROD). The early evidence suggests that the diagnosis of one of these disorders should point the physician to investigate for the presence of the other, especially if xanthogranulomatous disease is diagnosed first.
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Affiliation(s)
- Aleza A Andron
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
- Department of Ophthalmology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Akshay Gopinathan Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India
| | - David Della Rocca
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Robert C Della Rocca
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Harsha S Reddy
- Oculoplastic, Orbital, & Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
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Shinde S, Shenoy A. Cerebral CD1a positive Rosai–Dorfman disease with coexistent granulomatous angiitis: A case report. GLIOMA 2022. [DOI: 10.4103/glioma.glioma_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Essien F, Wolfley G, Tate J, Carroll M. Fevers, Sweats, Weight Loss, Oh My! When IgG4 Related Disease Comes Knocking. . . CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211046398. [PMID: 34733106 PMCID: PMC8558582 DOI: 10.1177/11795476211046398] [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] [Received: 06/11/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
Immunoglobulin G4-related systemic disease (IgG4-RSD) is a fibro-inflammatory immune condition characterized by IgG4 positive plasma cells, fibrosis, and frequently elevated serum IgG4 level. Akin to sarcoidosis, IgG4-RSD is a systemic disease with diverse organ manifestations linked by common histopathologic features. IgG4-RSD typically presents sub acutely without significant constitutional symptoms or fever. Hepatic Inflammatory pseudotumor (HIP) is a rare manifestation of IgG4-RSD composed of dense lymphoplasmacytic infiltrate and extensive fibrosis. We present an older Asian male who presented with acute onset of fever and weight loss found to have IgG4-RSD complicated by a HIP and concomitant MSSA abscess.
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Affiliation(s)
- Francis Essien
- Department of Internal Medicine, Keesler Air Force Base, Keesler Medical Center, Biloxi, MS, USA
| | - Graey Wolfley
- Department of Internal Medicine, Keesler Air Force Base, Keesler Medical Center, Biloxi, MS, USA
| | - Joshua Tate
- Department of Internal Medicine, Keesler Air Force Base, Keesler Medical Center, Biloxi, MS, USA.,Department of Internal Medicine, Division of Endocrinology, Keesler Air Force Base, Keesler Medical Center, Biloxi, MS, USA
| | - Matthew Carroll
- Department of Rheumatology, Singing River Health System, Ocean Springs, MS, USA
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Corines MJ, Krystel-Whittemore M, Murray M, Mango V. Uncommon Tumors and Uncommon Presentations of Cancer in the Breast. CURRENT BREAST CANCER REPORTS 2021; 13:331-346. [PMID: 36589040 PMCID: PMC9798716 DOI: 10.1007/s12609-021-00435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose of review The purpose is to present a case series of rare diagnoses and unusual presentations of breast lesions with radiologic-pathologic correlation from a major cancer center, and to review the recent literature on each entity with a focus on radiology-pathology concordance. We present our findings and experience from cases of metastatic small cell lung carcinoma to the breast, IgG-4 related breast disease, breast implant associated anaplastic large cell lymphoma, granular cell tumor, pleomorphic sarcoma, adenomyoepithelioma, post-radiation angiosarcoma, and breast carcinoma after risk-reducing total mastectomy. Recent findings It is essential for physicians to have knowledge of rare breast diagnoses and unusual breast disease presentations to formulate a complete differential diagnosis, recognize radiological-pathological concordance of these entities and provide appropriate patient care. Summary Current literature on these rare described entities exists mainly as case reports, case series and small-scale studies. By sharing our findings, we hope to educate trainees in radiology, pathology and other fields across the continuum of care in radiologic-pathologic correlation, while also augmenting the existing literature on these rare entities.
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Affiliation(s)
- Marina J. Corines
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 300 E 66th Street, New York, NY 10065,Corresponding author: Marina J. Corines, MD, 1275 York Ave, Department of Radiology, New York, New York, 10065, Telephone: (914) 319-6970,
| | | | - Melissa Murray
- Memorial Sloan Kettering Cancer Center, Department of Pathology, 1275 York Avenue, New York, NY 10065
| | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 300 E 66th Street, New York, NY 10065
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A Splenic IgG4+ Sclerosing Angiomatoid Nodular Transformation (SANT) Treated by Hemisplenectomy: A Radiologic, Histochemical, and Immunohistochemical Study. Appl Immunohistochem Mol Morphol 2021; 28:e40-e46. [PMID: 28777155 DOI: 10.1097/pai.0000000000000560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sclerosing angiomatoid nodular transformation (SANT) is a rare benign lesion of unknown origin for which total splenectomy is the standard treatment. CASE PRESENTATION A 54-year-old man with a history of recurrent pancreatitis, bicuspid aortic valve, and aortic dissection underwent abdominal ultrasound, Computed tomography and magnetic resonance imaging, which revealed a 6-cm hypoechoic splenic mass diagnosed as cavernous hemangioma. Owing to his relevant past history, he was considered eligible for emisplenectomy and not for total excision, which is associated with long-term risks, especially infections. RESULTS Histologic examination revealed several nodules of varying size separated by sclerotic stroma with scattered inflammatory cells rich in IgG4+ in a background of splenic red pulp. Immunohistochemical stains showed a characteristic panel for CD34, CD31, and CD8. CONCLUSIONS The diagnosis of SANT should be considered in any patient presenting with a splenic lesion containing an angiomatoid or inflammatory component. The only method able to establish a correct diagnosis is histologic and immunohistochemical evaluation. Complete splenectomy is generally considered the best approach. However, if the patient is at high risk of infection and localization of the lesion allows for selective devascularization of the affected part of the spleen, the lesion could be removed by hemisplenectomy. In some patients SANT is related to high blood levels of IgG4. Thus, corticosteroids might be useful for treating IgG4+ SANT and for preventing other IgG4-related diseases.
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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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Ekinci N, Unal Kocabey D, Gun E, Aslan F. Giant IgG4-Related Pseudotumor of the Esophagus Resected with Endoscopic Submucosal Dissection: A Case Report and Review of the Literature. Turk Patoloji Derg 2021; 37:258-263. [PMID: 33432560 PMCID: PMC10510622 DOI: 10.5146/tjpath.2020.01515] [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: 08/22/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a systemic autoimmune disorder that has been defined in various organs. The disease is characterized by typical clinicopathological features including a dense lymphoplasmacytic infiltrate rich in IgG4 positive plasma cells, storiform fibrosis, obliterative phlebitis, and often an elevated serum IgG4 level. Esophageal IgG4-RD is rare, and its presentation as a solid mass is even more rare. Only 15 previous cases of IgG4-related esophageal disease have been described. We herein present a case of giant IgG4-related pseudotumor of the esophagus resected with endoscopic submucosal dissection (ESD) and a review of the literature. The patient was a 67-year-old man who was admitted to our hospital for assessment of progressive dysphagia. Upper gastrointestinal endoscopy revealed a 9 cm mass in the cervical esophagus. In the previous two hospitals, the patient's mass could not be diagnosed despite repeated biopsies. Because of concerns regarding malignancy, endoscopic submucosal dissection was performed. Histopathological examination showed dense lymphoplasmacytic infiltration with predominant IgG4-positive plasma cells on a sclerotic background. The patient was diagnosed with IgG4-RD. During the follow-up, no residual mass was detected but the patient was diagnosed with lung adenocarcinoma. We present a unique case of giant IgG4-related pseudotumor of the esophagus. Resection with ESD of such a big mass of IgG4-RD in the esophageal region has never been reported before in the literature.
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Affiliation(s)
- Nese Ekinci
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Duygu Unal Kocabey
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Eylul Gun
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatih Aslan
- Department of Gastroenterology, Koc University Hospital, Istanbul, Turkey
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15
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Hashemi H, Thor A, Hellbacher E, Carlson M, Gulyás M, Blomstrand L. Localized IgG4-related disease manifested on the tongue: a case report. Ups J Med Sci 2021; 126:6118. [PMID: 34349889 PMCID: PMC8276348 DOI: 10.48101/ujms.v126.6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that can affect multiple organs. IgG4-RD may show a variety of initial symptoms. In the oral mucosa, lesions present as inflammatory fibrosis with a large number of IgG4-positive plasma cells. Evaluating treatment is a well-known problem in IgG4-RD due to the absence of an established assessment system. There are difficulties in defining the severity of the disease, which is why treatment is primarily based on its clinical manifestations. We present a case report of localized IgG4-RD with ulcerative and proliferative manifestations on the tongue, which clinically mimicked oral squamous cell carcinoma. A tumor-like lesion on the tongue can indicate something else other than the malignant or reactive changes commonly found in the oral mucosa. Multiple differential diagnoses of these atypical oral lesions, including localized IgG4-RD, should be considered.
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Affiliation(s)
- Helya Hashemi
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - Andreas Thor
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - Erik Hellbacher
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Marie Carlson
- Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden
| | - Miklós Gulyás
- Division of Pathology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lena Blomstrand
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
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Černá P, Kilpatrick S, Gunn-Moore DA. Feline comorbidities: What do we really know about feline triaditis? J Feline Med Surg 2020; 22:1047-1067. [PMID: 33100169 PMCID: PMC10814216 DOI: 10.1177/1098612x20965831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PRACTICAL RELEVANCE Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.
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Affiliation(s)
- Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, and Small Animal Clinic, The University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | | | - Danielle A Gunn-Moore
- The Royal (Dick) School of Veterinary Studies, and The Roslin Institute, University of Edinburgh, UK
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17
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IgG4-Related Sclerosing Disease Causing Spinal Cord Compression: The First Reported Case in Literature. Case Reports Immunol 2019; 2019:3618510. [PMID: 31316844 PMCID: PMC6604497 DOI: 10.1155/2019/3618510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is known for forming soft tissue mass lesions that may have compressive effects. It is an extremely rare disease that most frequently affects the pancreas causing autoimmune pancreatitis. It can also affect the gallbladder, salivary glands, and lacrimal glands causing respective organ-specific complications. In our report, we describe an IgG4-RD case that affected the spinal cord. A 60-year-old female presented with cervical spinal cord compression caused by IgG4-RD leading to several neurological deficits. Pathological examination of the excisional biopsy of the mass revealed dense lymphoplasmacytic cells infiltration and stromal fibrosis with IgG4 and plasma cells. The patient showed a dramatic response to the administration of systemic steroids with almost resolution of her neurological symptoms. This case highlights the first case in literature for IgG4-RD of the extradural tissue causing spinal compression. Hereby, we also demonstrate the dramatic response of IgG4-RD to the administration of systemic steroids as the patient had no recurrence after 5 years of close follow-up, the longest reported period of follow-up reported in the literature to date.
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Garrana SH, Buckley JR, Rosado-de-Christenson ML, Martínez-Jiménez S, Muñoz P, Borsa JJ. Multimodality Imaging of Focal and Diffuse Fibrosing Mediastinitis. Radiographics 2019; 39:651-667. [PMID: 30951437 DOI: 10.1148/rg.2019180143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fibrosing mediastinitis is a rare benign but potentially life-threatening process that occurs because of proliferation of fibrotic tissue in the mediastinum. The focal subtype is more common and typically is associated with an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young at presentation, but a wide age range has been reported, without a predilection for either sex. The diffuse form may be idiopathic or associated with autoimmunity, usually affects middle-aged and/or elderly patients, and is more common in men. For both subtypes, patients present with signs and symptoms related to obstruction or compression of vital mediastinal structures. The most common presenting signs and symptoms are cough, dyspnea, recurrent pneumonia, hemoptysis, and pleuritic chest pain. Patients with the diffuse subtype may have additional extrathoracic symptoms depending on the other organ systems involved. Because symptom severity is variable, treatment should be individualized with therapies tailored to alleviate compression of the affected mediastinal structures. Characteristic imaging features of fibrosing mediastinitis include infiltrative mediastinal soft tissue (with or without calcification) with compression or obstruction of mediastinal vascular structures and/or the aerodigestive tract. When identified in the appropriate clinical setting, these characteristic features allow the radiologist to suggest the diagnosis of fibrosing mediastinitis. Careful assessment is crucial at initial and follow-up imaging for exclusion of underlying malignancy, assessment of disease progression, identification of complications, and evaluation of treatment response. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Sherief H Garrana
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Jennifer R Buckley
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Santiago Martínez-Jiménez
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - Phillip Muñoz
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
| | - John J Borsa
- From the Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (S.H.G., J.R.B., M.L.R.d.C., S.M.J., J.J.B.); and Ameripath, Kansas City, Mo (P.M.)
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Sangha Brar JS, Gupta S, Haja Mohideen SM, Liauw L, Lath N. The pancreatic and extrapancreatic manifestations of IgG4-related disease. ACTA ACUST UNITED AC 2018. [PMID: 29467115 DOI: 10.5152/dir.2018.14319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The association between immunoglobulin IgG4 and autoimmune pancreatitis was first shown in 2001. Since then many previously established fibrosclerotic diseases demonstrating synchronous or metachronous multiorgan involvement have been included within the ambit of IgG4-related disease. Diagnostic criteria have been proposed involving 1) serum IgG4 level elevated beyond 135 mg/dL, 2) IgG4+ to IgG+ plasma cell ratio > 40% and >10 IgG4+ cells per high power field of biopsy sample and 3) a constellation of imaging features which involve a variety of organ systems. We present a pictorial essay demonstrating the spectrum of imaging findings for IgG4-related disease, including dacryosialadenitis, variety of renal lesions, tumefactive thickening of the extraocular muscles and orbital nerve, sclerosing cholangitis, and type I pancreatitis. Imaging plays an important role in diagnosis, screening for multiorgan involvement, and follow-up of the disease.
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Affiliation(s)
| | - Saurav Gupta
- Department of Diagnostic Radiology, Ng Teng Fong General Hospital, Jurong East, Singapore
| | | | - Lishya Liauw
- Diagnostic Radiology Service, Singapore General Hospital, Outram Road, Singapore
| | - Narayan Lath
- Diagnostic Radiology Service, Singapore General Hospital, Outram Road, Singapore
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20
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Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
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Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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21
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Suimon Y, Kase S, Ishijima K, Kanno-Okada H, Ishida S. A clinicopathological study on IgG4-related ophthalmic disease. Int J Ophthalmol 2018; 11:1539-1544. [PMID: 30225231 DOI: 10.18240/ijo.2018.09.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/18/2018] [Indexed: 12/24/2022] Open
Abstract
AIM To investigate clinicopathological features of immunoglobulin G4-related ophthalmic disease (IgG4-ROD), and analyze the recurrence rates following systemic corticosteroid administration. METHODS We retrospectively searched clinical features, laboratory and histological findings based on the medical records of 21 patients with IgG4-ROD. All the patients examined in this study underwent surgical resection in the ocular adnexal lesions and underwent histological evaluation. This study further investigated clinical and histopathological features of 15 patients who received systemic corticosteroid after the resection. RESULTS The mean age of the patients consisting of 7 males (33%) and 14 females (67%) was 61y. Fourteen patients were diagnosed as definitive, and 2 and 5 patients were probable and possible IgG4-ROD, respectively. Eyelid swelling was an initial symptom in 11 patients (52%) who did not show systemic involvements at a diagnosis. Fifteen patients received systemic corticosteroid administration, and all showed remission of inflammation. Among them, 10 patients did not recur, whereas 5 patients (33%) recurred during tapering. There were no significant difference between patients with or without recurrence in clinicopathological features. CONCLUSION In this study, female patients are more predominant in IgG4-ROD. While inflammation recurs in one-third of patients, this study do not identify factors associated with recurrence after systemic corticosteroid administration.
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Affiliation(s)
- Yuka Suimon
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Kan Ishijima
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Hiromi Kanno-Okada
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
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22
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Sandrasegaran K, Menias CO. Imaging in Autoimmune Pancreatitis and Immunoglobulin G4-Related Disease of the Abdomen. Gastroenterol Clin North Am 2018; 47:603-619. [PMID: 30115440 DOI: 10.1016/j.gtc.2018.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Autoimmune pancreatitis (AIP) is steroid-responsive fibroinflammatory disorder of the pancreas. There are 2 distinct subtypes of AIP, types 1 and 2. Type 1 is associated with systemic immunoglobulin (Ig)G4 disease and may affect multiple organs in the body. Type 2 is confined to the pancreas and shows an association with ulcerative colitis. This article describes the imaging findings of AIP and IgG4 disease in the liver, bile ducts, kidneys, and the retroperitoneal regions. The imaging differentiation of AIP from pancreas cancer is discussed.
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Affiliation(s)
- Kumaresan Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 550 North University Boulevard, UH0279, Indianapolis, IN 46202, USA.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Boban J, Ardalı S, Thurnher MM. Leptomeningeal form of Immunoglobulin G4-related hypertrophic meningitis with perivascular spread: a case report and review of the literature. Neuroradiology 2018; 60:769-773. [PMID: 29736618 PMCID: PMC5995998 DOI: 10.1007/s00234-018-2028-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/24/2018] [Indexed: 12/24/2022]
Abstract
Purpose Immunoglobulin G4 (IgG4)-related disease represents a spectrum of fibro-inflammatory disorders that affects various organ systems, including the central nervous system. Methods Here we present the case of lgG4-related hypertrophic meningitis with exclusively leptomeningeal involvement and spread via perivascular spaces. Results A 58-year-old male patient presented with complex partial seizures. Initial computed tomography examination showed left frontal sulcal hyperdensity. Subsequent magnetic resonance examination revealed FLAIR hyperintensity in the central sulcus, with post-contrast enhancement in the form of “dotted line.” Physical examination, routine laboratory, and cerebrospinal fluid analyses were unremarkable. Meningeal biopsy confirmed IgG4-related meningitis. After corticosteroid treatment, a complete resolution of imaging findings was observed. Two months later, the patient presented with relapsing neurological symptoms and radiological findings in postcentral, precentral, and temporal sulci, resembling the form of “dotted line” contrast enhancement. In addition, linear intraparenchymal enhancement that followed perivascular spaces was seen in the left parietal lobe. After repeated steroid therapy, all lesions resolved completely. Conclusion We reported the first case of isolated IgG4-related leptomeningeal involvement with a “dotted line” enhancement and perivascular intraparenchymal spread. Although IgG4-related meningitis represents a rare disease, both clinicians and radiologists should include this condition in the differential diagnosis of unclear leptomeningeal disease.
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Affiliation(s)
- Jasmina Boban
- Faculty of Medicine, Department for Radiology, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia
| | - Selin Ardalı
- Department of Radiology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey
| | - Majda M Thurnher
- Section of Neuroradiology and Musculoskeletal Radiology, Department for Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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24
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Son HJ, Yu IK, Kim SM. Lymphoplasmacyte-Rich Meningioma With Atypical Angiomatous Feature and an Increased Deposition of IgG4-Positive Plasma Cells: An Unusual Case Report. Int J Surg Pathol 2018; 26:93-97. [PMID: 28862040 DOI: 10.1177/1066896917728103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lymphoplasmacyte-rich meningioma (LPRM) is an extremely rare variant of meningioma, and a small percentage of LPRM may be associated with IgG4-related disease. To date, the coexistence of 2 rare meningioma variants consisting of LPRM and angiomatous meningioma within one neoplasm has not been reported in the literature. A 56-year-old woman presented with episodes of frequent and severe epistaxis that began 4 months ago. Initial magnetic resonance imaging showed localized, heterogeneous, and intermediate to high signal lesion at the odontoid process and clivus. In subsequent magnetic resonance images, the mass grew to the posterior nasopharyngeal wall, and compression to the medulla, and a suspicious enhancement of both distal vertebral arteries became evident even though there was 3 times of partial resection over 17 years. The tumor showed regional and temporal heterogeneity, and atypical features such as mitoses and a high proliferative index were also identified in the area of angiomatous meningioma in addition to LPRM with an increased deposition of IgG4-positive plasma cells within the neoplasm.
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Affiliation(s)
| | - In Kyu Yu
- 1 Eulji University, Daejeon, Republic of Korea
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25
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Sheng RF, Zhai CW, Ji Y, Chen CZ, Yang L, Zeng MS. Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor. Hepatobiliary Pancreat Dis Int 2017; 16:631-637. [PMID: 29291783 DOI: 10.1016/s1499-3872(17)60062-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 05/16/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatic inflammatory pseudotumor (IPT) is classified into 2 types based on IgG4 stain: IgG4-related and non-IgG4-related; the two types differ not only in their pathological characteristics, but also in the clinical features. This study aimed to investigate the MR character of hepatic IPT, and differentiate the IgG4-related IPT from the non-IgG4-related IPT. METHODS Twenty-five patients with 27 histologically proven hepatic IPTs were retrospectively analyzed. Ten lesions were diagnosed as IgG4-related IPT, and the other 17 as non-IgG4-related IPT. The MR signal features on T1, T2-weighted, dynamic-enhanced, and diffusion-weighted imaging were evaluated and compared. RESULTS The dominant lesions were subcapsularly distributed (n=17, 63.0%) with clear boundary (n=20, 74.1%), and showed progressive enhancement pattern (n=21, 77.8%) with diffuse homogeneous (n=12, 44.4%) or heterogeneous (n=8, 29.6%) hyperintensity, accompanied by delayed capsule-like enhancement (n=17, 63.0%) and central nonenhanced areas (n=18, 66.7%). Morphological features (P>0.05) were not sufficient to differentiate IgG4-related IPT from non-IgG4-related IPT; the wash-out pattern was only found in 2 IgG4-related IPT, while the progressive enhancement pattern was more common in the non-IgG4-related lesions (n=16) (P=0.022). During portal and delayed phases, iso-/hypoenhanced lesions were only seen in 3 IgG4-related IPT, and circular-enhanced lesions (n=5) existed exceptionally in the non-IgG4-related group with significant differences (P=0.029 and 0.027). Most IgG4-related IPTs had lower apparent diffusion coefficient compared with the liver parenchyma (n=6), while most non-IgG4-related IPTs had higher apparent diffusion coefficient value (n=13) (P=0.046). CONCLUSIONS Although MR images of hepatic IPT have certain characteristics, they are not enough to differentiate IgG4-related IPT from non-IgG4-related IPT. The enhancement pattern, signal features on portal and delayed phases, and the apparent diffusion coefficient value of the lesion may be helpful for the diagnosis.
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Affiliation(s)
- Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Chang-Wen Zhai
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Cai-Zhong Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
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Andron A, Hostovsky A, Nair AG, Sagiv O, Schiby G, Simon GB. The impact of IgG-4-ROD on the diagnosis of orbital tumors: A retrospective analysis. Orbit 2017; 36:359-364. [PMID: 28829660 DOI: 10.1080/01676830.2017.1337192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
This study was to determine the prevalence of immunoglobulin G4 (IgG4)-related orbital disease (IgG4-ROD) among patients who have previously undergone biopsy and were diagnosed to have idiopathic orbital inflammatory disease (IOID) or orbital lymphoproliferative disease (OLD), namely, lymphoma and benign reactive lymphoid hyperplasia (BRLH). This is a retrospective cross-sectional study. The charts and slides of all patients who underwent biopsies and were histopathologically diagnosed to have either IOID or OLD were reviewed. Demographics, clinical features, initial histopathological diagnoses, treatment received, and final outcome were noted. Using the diagnostic criteria for diagnosis for IgG4 disease, those cases that would classify as "possible IgG4-related disease (IgG4-RD)" were reviewed, reclassified, and reassigned a diagnosis of IgG4-ROD. We reviewed 105 patients' clinical charts. Of these 105 patients, upon reviewing the histopathology, 18 (17.15%) patients were found to fit the diagnostic criteria for possible IgG4-ROD. Of these 18 patients who were now reassigned the diagnosis of IgG4-ROD, the most common previous histopathological diagnosis was found to be IOID, for eight patients (44%), then BRLH, which was noted in five patients (27.8%), followed by lymphoma, which was noted in two patients (11.1%). Previously diagnosed cases of IOID and OLD were found to fulfill the criteria for IgG4-ROD. Given the advent of recent diagnostic and histopathological techniques, all cases of suspected IOID and OLD should be screened for IgG4-ROD and all previously diagnosed cases must be closely followed up, given the systemic implication of IgG4-RD. Histopathological reassessment of previously diagnosed cases may be considered.
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Affiliation(s)
- Aleza Andron
- a New York Eye and Ear Infirmary of Mount Sinai , New York , New York , USA
| | | | | | - Oded Sagiv
- b Sheba Medical Center , Tel Hashomer , Israel
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Kouhpayeh S, Andalib A, Gharagozloo M, Sanei MH, Esmaeil N, Maracy MR. Evaluation of Urokinase Plasminogen Activator Receptor, Soluble Urokinase Plasminogen Activator Receptor, and β1 Integrin in Patients with Hodgkin's Lymphoma. Adv Biomed Res 2017; 6:108. [PMID: 28904936 PMCID: PMC5590394 DOI: 10.4103/2277-9175.213668] [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: 11/12/2022] Open
Abstract
Background: The objective of this study is to indicate the role of urokinase plasminogen activator receptor (uPAR), soluble uPAR (suPAR), and β1 integrin in tumor growth and invasion of lymph nodes from Hodgkin's lymphoma (HL) patients. Materials and Methods: In this study, 25 lymph nodes from HL patients were analyzed for the expression of β1 integrin and uPAR on mononuclear cells using two-color flow cytometry and immunohistochemical analysis. Moreover, the levels of suPAR in the serum samples of HL patients were measured and compared with 32 healthy controls. Results: Flowcytometry and immunohistochemical results indicated no significant association of uPAR expression with tumor size, different stages, or different histological subtypes of HL; however, an increased expression of β1 integrin was detected in the advanced stages of HL. Higher expression of β1 integrin was detected in nodular sclerosis compared to lymphocyte predominant. No significant difference was observed between the serum levels of suPAR in patients with different stages of HL and healthy controls. Moreover, the levels of suPAR were significantly higher in nodular sclerosis in comparison with other subtypes. Conclusions: This study showed that the levels of suPAR and β1 integrin varied between different histological subtypes of HL. Although uPAR may play only a minor role in the growth and metastasis of lymphoma, β1 integrin may be important in predicting prognosis and metastasis in HL.
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Affiliation(s)
- Shirin Kouhpayeh
- Department of Immunology, Isfahan Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Andalib
- Department of Immunology, Isfahan Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Gharagozloo
- Department of Immunology, Isfahan Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Sanei
- Department of Pathology, Isfahan Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Esmaeil
- Department of Immunology, Isfahan Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Sebastian A, Sebastian M, Misterska-Skóra M, Donizy P, Hałoń A, Chlebicki A, Lipiński A, Wiland P. The variety of clinical presentations in IgG4-related disease in Rheumatology. Rheumatol Int 2017; 38:303-309. [PMID: 28856463 PMCID: PMC5773660 DOI: 10.1007/s00296-017-3807-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/21/2017] [Indexed: 12/13/2022]
Abstract
IgG4-related disease (IgG4-RD) belongs to the group of rare diseases in which the identification of the characteristic histology and immunohistochemistry provides with the gold standard in the diagnosis. The variable organ dysfunction reflects the clinical presentation. The examples of different IgG4-RD presentations in the Rheumatology Unit were discussed in this article. The spectrum of IgG4-RD is wide-ranging and manifested in one or more organs synchronously or metachronously. In the presented article, we described five different cases of IgG4-RD. Four cases were reaffirmed in the histopathological assessment. The clinical and laboratory findings were analyzed and the assigned therapy was discussed. According to our experience, the diagnosis of IgG4-RD requires the careful clinicopathological correlation. The diagnosis relies on the coexistence of various clinical, laboratory, radiological, and histopathological findings, although none of them is pathognomonic itself. The time needed for the diagnosis and variety of clinical forms of IgG4-RD shows that there is need of the cooperation among many specialists for the better and earlier recognition of the disease.
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Affiliation(s)
- Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Borowska 213, 50-556, Wroclaw, Poland.
| | - Maciej Sebastian
- Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical Hospital, Borowska 213, 50-556, Wroclaw, Poland
| | - Maria Misterska-Skóra
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Borowska 213, 50-556, Wroclaw, Poland
| | - Piotr Donizy
- Division of Pathomorphology and Clinical Cytology, Department of Pathomorphology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Agnieszka Hałoń
- Division of Pathomorphology and Clinical Cytology, Department of Pathomorphology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Arkadiusz Chlebicki
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Borowska 213, 50-556, Wroclaw, Poland
| | - Artur Lipiński
- Division of Pathomorphology and Clinical Cytology, Department of Pathomorphology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Li QJ, Zhao PX, Zhang XJ, Yi Y, Cheng DY, Ma JM, Ma XM. Association of the macrophage migration inhibitory factor promoter polymorphisms with benign lymphoepithelial lesion of lacrimal gland. Int J Ophthalmol 2017; 10:1229-1232. [PMID: 28861347 DOI: 10.18240/ijo.2017.08.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/16/2017] [Indexed: 12/24/2022] Open
Abstract
AIM To identify the association of the macrophage migration inhibitory factor (MIF) gene polymorphism with the susceptibility of benign lymphoepithelial lesions (BLEL) of the lacrimal gland. METHODS A total of 40 BLEL of lacrimal gland cases were matched with 40 healthy subjects (HS). Extraction the plasma and whole blood DNA of patients of lacrimal gland BLEL and HS. Elisa and polymerase chain reaction was used to determine in plasma contents of MIF and MIF gene SNP-173G>C and STR -794 CATT(5-8) polymorphism, respectively. RESULTS The MIF levels in plasma were significantly higher in patients with lacrimal gland BLEL versus HS (P<0.001). The -173 G>C MIF polymorphism was significantly associated with lacrimal gland BLEL, with a significantly higher frequency of the C allele in lacrimal gland BLEL patients compared with HS (OR=2.38, 95% CI=1.07-5.31, P=0.032), and the -173 C/x is more frequent in patients than in HS, P=0.037. Besides, we found that the carriage rate of the MIF -173C/x is associated with higher plasma levels of MIF in the BLEL of lacrimal gland. CONCLUSION MIF -173G/C variants play an insidious role in susceptibility of BLEL of lacrimal gland. Otherwise, there is no statistically significant correlation exists between MIF-794 CATT (5-8) and BLEL of lacrimal gland.
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Affiliation(s)
- Qin-Jian Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Peng-Xiang Zhao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Xu-Juan Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Yang Yi
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Dan-Ying Cheng
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jian-Min Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology &Vision Science Key Lab, Beijing 100730, China
| | - Xue-Mei Ma
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
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Aguirre V, Connolly C, Stuklis R. IgG4-Aortopathy: An Underappreciated Cause of Non-Infectious Thoracic Aortitis. Heart Lung Circ 2017; 26:e79-e81. [PMID: 28511923 DOI: 10.1016/j.hlc.2017.03.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/12/2017] [Indexed: 12/23/2022]
Abstract
IgG4 related thoracic aortitis is a recent addition to the differential diagnosis for inflammatory aortic disease - a condition which is often underappreciated until complications arise such as aneurysmal formation or aortic dissection. Currently, IgG4 aortitis remains a post-surgical diagnosis reliant on positive immunohistochemistry findings. Management is guided by the extent of disease involvement, which can be gauged by serum IgG4 levels and radiological findings. Options include surgical resection, corticosteroid therapy and steroid-sparing agents to prevent relapses.
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Affiliation(s)
- Victor Aguirre
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Catherine Connolly
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert Stuklis
- Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
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Decker L, Crawford AM, Lorenzo G, Stippler M, Konstantinov KN, SantaCruz K. IgG4-Related Hypophysitis: Case Report and Literature Review. Cureus 2016; 8:e907. [PMID: 28083451 PMCID: PMC5208633 DOI: 10.7759/cureus.907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IgG4-related hypophysitis is a rare, inflammatory process of the pituitary that mimics more commonly seen pituitary tumors. We report a case of IgG4-related hypophysitis in a 16-year-old female with diabetes insipidus who was found to have IgG4-related hypophysitis based on tissue diagnosis. This entity has not been previously described in a pediatric patient. Recognition of certain inflammatory processes of the pituitary may lead to alternative means of diagnosis and medical management without a biopsy.
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Affiliation(s)
- Lauren Decker
- Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | - Gamaliel Lorenzo
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | | | - Karen SantaCruz
- Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Abstract
PURPOSE To evaluate ophthalmic involvement of systemic immunoglobulin-G4-related disease (IgG4-RD) and describe the changes in both ocular surface parameters and corneal subbasal nerve plexus. MATERIALS AND METHODS Twenty eyes of 10 patients with systemic IgG4-RD and 20 eyes of 10 control subjects were enrolled in this study. Demographic information, medical history, serum IgG4 levels, orbital imaging, and follow-up data of subjects were recorded. Ocular surface tests were carried out in the order of tear break-up time (BUT), lissamine green (LG) staining, Schirmer I test with anesthesia, and ocular surface disease index (OSDI) questionnaire for all participants. Corneal subbasal nerves and basal epithelial cell layer were evaluated using in vivo confocal microscopy. RESULTS Among the 10 patients with IgG4-RD, 11 eyes of 7 patients had orbital involvement. Among these 7 patients with IgG4-related ophthalmic disease, 4 presented with painless eyelid or periorbital swelling, 2 with diplopia and restricted ocular motility, and 1 with proptosis. Patients with IgG4-RD had higher OSDI (5.9 ± 6.6 vs. 1.7 ± 2.4, P < 0.001) and LG staining scores (0.7 ± 1.0 vs. 0.0 ± 0.0, P = 0.011) and lower BUT (5.6 ± 1.4 vs. 10.2 ± 1.0, P < 0.001) and Schirmer values (11.9 ± 10.3 vs. 18.3 ± 4.4, P = 0.021) as compared with those of control subjects. Total nerve density and nerve fiber length were found to be significantly lower in patients with IgG4-RD. CONCLUSIONS The orbit is frequently involved during the course of IgG4-RD. These patients should be evaluated in terms of ocular surface disease and dry eye, which may be associated with lacrimal gland and/or orbital nerve involvement.
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Li L, Ward B, Cocks M, Kheradmand A, Francis HW. IgG4-Related Disease of Bilateral Temporal Bones. Ann Otol Rhinol Laryngol 2016; 126:236-240. [PMID: 27729479 DOI: 10.1177/0003489416672476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD) is an idiopathic inflammatory condition that causes pseudotumor formation in single or multiple organs, including those of the head and neck. Temporal bone involvement is rare, with only 3 cases of unilateral temporal bone IgG4-RD described in the literature. We report the first known case of IgG4-RD of bilateral temporal bones and describe its clinical presentation, diagnosis, and treatment. METHODS The patient was a 52-year-old man with latent tuberculosis (TB) who presented with a 10-year history of bilateral profound hearing loss and vestibular dysfunction. Computed tomography and magnetic resonance imaging demonstrated bilateral labyrinthine destruction with invasion of the posterior fossa. RESULTS Immunoglobulin level testing showed elevated total serum IgG levels with normal IgG4 levels. Bilateral mastoidectomies were performed, with biopsy samples demonstrating IgG4 staining with IgG4-positive plasma cells up to 40/HPF (high power field) on the right and 20/HPF on the left, consistent with bilateral IgG4-RD. CONCLUSION IgG4-RD of bilateral temporal bones presents with chronic and progressive bilateral hearing loss and vestibular dysfunction. Clinical presentation and radiologic findings are nonspecific, and definitive diagnosis must be made with histopathology and immunostaining. Corticosteroids are therapeutic, but surgical resection may be necessary for temporal bone IgG4-RD to improve long-term remission.
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Affiliation(s)
- Lilun Li
- 1 Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA.,2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bryan Ward
- 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Margaret Cocks
- 3 Department of Pathology, Johns Hopkins Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amir Kheradmand
- 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,4 Department of Neurology, Johns Hopkins Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Howard W Francis
- 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Al Sannaa G, Wimmer JL, Ayala AG, Ro JY. An isolated inflammatory myofibroblastic tumor of adrenal gland. Ann Diagn Pathol 2016; 25:33-36. [PMID: 27806843 DOI: 10.1016/j.anndiagpath.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 01/25/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon lesion that shows a wide range of anatomic distribution. The adrenal gland, however, is a distinctly rare site of occurrence. To date, only a few cases of IMT arising in the adrenal gland have been reported in the English literature. Here, we report another case of isolated adrenal IMT. A 34-year-old man presented to the emergency department with a complaint of a sudden severe right-sided back pain. Subsequent computed tomographic scan imaging studies demonstrated a large right adrenal mass associated with a hematoma. The right adrenal gland was resected. Microscopic examination revealed an encapsulated cellular spindle cell proliferation with a prominent inflammatory infiltrate. Immunohistochemically, those spindle cells were diffusely and strongly positive for anaplastic lymphoma kinase-1, and focally and weakly positive for smooth muscle actin. S-100 protein and cytokeratin were negative. The findings were consistent with IMT arising from the adrenal gland. Although IMTs in the adrenal gland are rare, they should be considered in the differential diagnosis of adrenal masses. The clinical behavior of IMTs in general is currently indeterminate and a close clinical follow-up is recommended. The behavior of adrenal IMTs remains uncertain because of rare reported cases and lack of long-term follow-up. Further follow-up of reported cases and recognition of additional new cases is warranted to unmask the true biological behavior of adrenal IMTs.
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Affiliation(s)
- Ghadah Al Sannaa
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jana L Wimmer
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Alberto G Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.
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McCrary HC, Faucett EA, Erman AB. Immunoglobulin G4-related sclerosing disease Mimicking sjogren's syndrome: A case report. Laryngoscope 2016; 126:2242-5. [PMID: 27296721 DOI: 10.1002/lary.26112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/09/2022]
Abstract
Immunoglobulin G4-related sclerosing disease (IgG4-RSD) is a fibroinflammatory condition that has the potential to affect nearly every organ system. Classic histological findings include storiform fibrosis and lymphoplasmacytic infiltrates of immunoglobulin G4 (IgG4)-positive plasma cells. The clinical features of IgG4-RSD may be an under-recognized disease process that can mimic other autoimmune disorders, including Sjogren's syndrome. We describe a rare case of IgG4-RSD involving the salivary glands, initially misdiagnosed as Sjogren's syndrome. Clinical features of IgG4-RSD can mimic those of other autoimmune disorders affecting the head and neck. Therefore, otolaryngologists should have IgG4-RSD on their differential when evaluating patients with diffuse salivary gland swelling. Laryngoscope, 126:2242-2245, 2016.
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Affiliation(s)
- Hilary C McCrary
- University of Arizona College of Medicine, Tucson, Arizona, U.S.A..
| | - Erynne A Faucett
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, U.S.A
| | - Audrey B Erman
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, U.S.A
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Delteil C, Chesnais AL, Tasei AM, Cohen-Pansieri C, Naffaa N, Granier G. [Immunoglobulin G4-related lung disease: Case report and literature review]. Ann Pathol 2016; 36:218-21. [PMID: 27231189 DOI: 10.1016/j.annpat.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 01/13/2023]
Abstract
We report the case of a 61-year-old man with a pulmonary nodule discovered while staging the metastasis of a squamous cell carcinoma. No primary cancer was found. Histological examination of the resected specimen (lingula) was in favor of IgG4-related inflammatory pseudotumor. Histological criteria were described in 2012, combining a dense lymphoplasmacitic infiltrate rich in IgG4-positive plasma cell, storiform fibrosis and obliterative phlebitis. IgG4/IgG plama cell ratio>40 % is mandatory for histological diagnosis of IgG4-related disease. This is a rare and often underdiagnosed disease. Diagnostic criteria are now defined and consensual, combining clinical signs, biology and histology.
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Affiliation(s)
- Clémence Delteil
- Service de pathologie, hôpital Henri-Duffaut, centre hospitalier d'Avignon, 84000 Avignon, France.
| | - Anne-Laure Chesnais
- Service de pathologie, hôpital Henri-Duffaut, centre hospitalier d'Avignon, 84000 Avignon, France
| | - Anne-Marie Tasei
- Service de pathologie, hôpital Henri-Duffaut, centre hospitalier d'Avignon, 84000 Avignon, France
| | - Carole Cohen-Pansieri
- Service de pathologie, hôpital Henri-Duffaut, centre hospitalier d'Avignon, 84000 Avignon, France
| | - Nidal Naffaa
- Service de chirurgie vasculaire et thoracique, hôpital Henri-Duffaut, centre hospitalier d'Avignon, 84000 Avignon, France
| | - Guillaume Granier
- Service de pathologie, hôpital Henri-Duffaut, centre hospitalier d'Avignon, 84000 Avignon, France
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Ewing DE, Hammer RD. IgG4-related disease simulating Hodgkin lymphoma in a child. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Abstract
Orbital sclerosing inflammation is a distinct group of pathologies characterized by indolent growth with minimal or no signs of inflammation. However, contrary to earlier classifications, it should not be considered a chronic stage of acute inflammation. Although rare, orbital IgG4-related disease has been associated with systemic sclerosing pseudotumor-like lesions. Possible mechanisms include autoimmune and IgG4 related defective clonal proliferation. Currently, there is no specific treatment protocol for IgG4-related disease although the response to low dose steroid provides a good response as compared to non-IgG4 sclerosing pseudotumor. Specific sclerosing inflammations (e.g. Wegener's disease, sarcoidosis, Sjogren's syndrome) and neoplasms (lymphoma, metastatic breast carcinoma) should be ruled out before considering idiopathic sclerosing inflammation as a diagnosis.
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Affiliation(s)
- Gautam Lokdarshi
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Neelam Pushker
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Mandeep S Bajaj
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Rodrigues J, Diehl DL. Cholangiocarcinoma: Clinical manifestations and diagnosis. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2016. [DOI: 10.1016/j.tgie.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Complement System in the Pathogenesis of Benign Lymphoepithelial Lesions of the Lacrimal Gland. PLoS One 2016; 11:e0148290. [PMID: 26849056 PMCID: PMC4743846 DOI: 10.1371/journal.pone.0148290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/15/2016] [Indexed: 12/24/2022] Open
Abstract
Objective We aimed to examine the potential involvement of local complement system gene expression in the pathogenesis of benign lymphoepithelial lesions (BLEL) of the lacrimal gland. Methods We collected data from 9 consecutive pathologically confirmed patients with BLEL of the lacrimal gland and 9 cases with orbital cavernous hemangioma as a control group, and adopted whole genome microarray to screen complement system-related differential genes, followed by RT-PCR verification and in-depth enrichment analysis (Gene Ontology analysis) of the gene sets. Results The expression of 14 complement system-related genes in the pathologic tissue, including C2, C3, ITGB2, CR2, C1QB, CR1, ITGAX, CFP, C1QA, C4B|C4A, FANCA, C1QC, C3AR1 and CFHR4, were significantly upregulated while 7 other complement system-related genes, C5, CFI, CFHR1|CFH, CFH, CD55, CR1L and CFD were significantly downregulated in the lacrimal glands of BLEL patients. The microarray results were consistent with RT-PCR analysis results. Immunohistochemistry analysis of C3c and C1q complement component proteins in the resected tissue were positive in BLEL patients, while the control group had negative expression of these proteins. Gene ontology (GO) analysis revealed that activation of the genes of complement system-mediated signaling pathways were the most enriched differential gene group in BLEL patients. Conclusions Local expression of complement components is prominently abnormal in BLEL, and may well play a role in its pathogenesis.
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Alvarez Argote J, Bauer FA, Posteraro AF, Dasanu CA. Retroperitoneal fibrosis due to B-cell non-Hodgkin lymphoma: Responding to rituximab! J Oncol Pharm Pract 2016; 22:179-85. [PMID: 25013186 DOI: 10.1177/1078155214543279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Retroperitoneal fibrosis is a rare disease manifesting as chronic soft tissue fibrosis in the retroperitoneum, with potential anatomic and/or functional compromise of adjacent organs. It can be primary (idiopathic) or secondary to other conditions such as cancers, autoimmune disorders, or drugs. We report herein a 66-year-old patient with symptomatic retroperitoneal fibrosis leading to bilateral hydronephrosis and renal failure, in whom, after a complex diagnostic work-up and protracted clinical course, a B-cell non-Hodgkin lymphoma in the retroperitoneal space and several vertebral bodies was identified. The patient was treated with radiation therapy and weekly rituximab infusions, with resolution of hydronephrosis and lower back pain. We include a thorough literature review on etiopathogenesis, diagnosis, therapy, and prognosis of retroperitoneal fibrosis. A meticulous search for malignancy is necessary in this rare condition that, if positive, may have significant therapeutic and prognostic implications.
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Affiliation(s)
| | - Frank A Bauer
- Department of Pathology, St. Francis Hospital and Medical Center, Hartford, USA
| | - Anthony F Posteraro
- Department of Radiology, St. Francis Hospital and Medical Center, Hartford, USA
| | - Constantin A Dasanu
- Department of Hematology-Oncology, St. Francis Hospital and Medical Center, Hartford, USA
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Farooq TA, Mudhar H, Sandramouli S. A case of non-lacrimal immunoglobulin G4 (IgG4)-related orbital disease with mastitis. Orbit 2015; 35:16-9. [PMID: 26700191 DOI: 10.3109/01676830.2015.1099690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IgG4-related orbital disease is a recognised cause for orbital inflammation. As its awareness increases and diagnostic accuracy improves there will be an increased number of cases being identified. This unique case demonstrates for the first time, with histological evidence, a case of a non-lacrimal IgG4-related orbital disease with concurrent IgG4-related mastitis. We describe a 47 year old who presented with a supraorbital swelling and mass. This was initially successfully treated with oral steroids and was later excised on recurrence. Immunohistochemical and blood serum analysis confirmed IgG4-related orbital disease. On systemic enquiry she was found to have a mass of the breast, which was shown to be IgG4-related mastitis. She is currently asymptomatic with no sign of recurrence and is under long-term surveillance. This case highlights the importance of systemic work up in patients presenting with orbital foci of IgG4 disease.
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Affiliation(s)
- Tahir Ali Farooq
- a Wolverhampton Eye Infirmary, Ophthalmology , Wolverhampton , United Kingdom.,b BMEC, Ophthalmology, City Hospital , Birmingham , United Kingdom
| | - Hardeep Mudhar
- c Royal Hallamshire Hospital, Sheffield Teaching Hospitals , Sheffield , United Kingdom
| | - S Sandramouli
- d Wolverhampton Eye Infirmary, Ophthalmology, New Cross Hospital , Wolverhampton , United Kingdom
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Oles K, Sładzień J, Bartuś K, Leszczyńska J, Bojanowska E, Krakowczyk Ł, Mika J. Characteristics, diagnosis and therapeutic strategies for IgG4-related orbital disease. Pharmacol Rep 2015; 68:507-13. [PMID: 27116895 DOI: 10.1016/j.pharep.2015.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/24/2022]
Abstract
Thanks to detailed studies conducted in recent years, a new disease syndrome was identified in 2001. It is known as a IgG4-related disease and its differentiation is based on the analysis of IgG4 levels in the affected tissues. The IgG4-related disease is considered to be a generalized pathological process involving a wide spectrum of various disorders that may affect distant organs. Orbital IgG4-related disease is a recently reported issue that may prove important for the elucidation of the etiology of idiopathic, lymphoplasmacytic or fibrotic disorders of various organs, including the orbits. In this article, we are describing epidemiology and differential diagnostics of IgG4-related orbital disease with particular focus on pseudotumors, MALT lymphomas and lymphocyte/plasma cell infiltrations of the orbit. We are also discussing therapeutic possibilities currently available in the management of the disease.
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Affiliation(s)
- Krzysztof Oles
- Department of Oncological and Reconstructive Surgery, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland.
| | - Jacek Sładzień
- Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
| | - Krzysztof Bartuś
- Department of Cardiac and Vascular Surgery and Transplantology, The Institute of Cardiology, Medical College Jagiellonian University, John Paul II Hospital, Kraków, Poland.
| | - Joanna Leszczyńska
- Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
| | - Emila Bojanowska
- Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
| | - Łukasz Krakowczyk
- Department of Oncological and Reconstructive Surgery, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland.
| | - Joanna Mika
- Department of Pain Pharmacology, Institute of Pharmacology, Kraków, Poland.
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Jeong HJ, Shin SJ, Lim BJ. Overview of IgG4-Related Tubulointerstitial Nephritis and Its Mimickers. J Pathol Transl Med 2015; 50:26-36. [PMID: 26666884 PMCID: PMC4734970 DOI: 10.4132/jptm.2015.11.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 12/18/2022] Open
Abstract
Tubulointerstitial nephritis (TIN) is the most common form of renal involvement in IgG4-related disease. It is characterized by a dominant infiltrate of IgG4-positive plasma cells in the interstitium and storiform fibrosis. Demonstration of IgG4-positive plasma cells is essential for diagnosis, but the number of IgG4-positive cells and the ratio of IgG4-positive/IgG-positive plasma cells may vary from case to case and depending on the methods of tissue sampling even in the same case. IgG4-positive plasma cells can be seen in TIN associated with systemic lupus erythematosus, Sjögren syndrome, or anti-neutrophil cytoplasmic antibody–associated vasculitis, which further add diagnostic confusion and difficulties. To have a more clear view of IgG4-TIN and to delineate differential points from other TIN with IgG4-positive plasma cell infiltrates, clinical and histological features of IgG4-TIN and its mimickers were reviewed. In the rear part, cases suggesting overlap of IgG4-TIN and its mimickers and glomerulonephritis associated with IgG4-TIN were briefly described.
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Affiliation(s)
- Hyeon Joo Jeong
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Su-Jin Shin
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Jin Lim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Wang Z, Feng R, Chen Y, Duan M, Wang M, Jin Z, Rumboldt Z, Zhang Z. CT features and pathologic characteristics of IgG4-related systemic disease of submandibular gland. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:16111-16116. [PMID: 26884889 PMCID: PMC4730102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
The submandibular gland is one of the most frequently affected salivary gland in IgG4-related systemic disease, usually demonstrate homogeneous attenuation on CT imaging as reported, but without much pathological comparison of many cases. This article is to investigate and analyze the typical CT findings and pathologic characteristics of IgG4-related systemic disease (IgG4-RSD) of submandibular gland. A retrospective analysis of the preoperative CT findings in patients with IgG4-RSD of submandibular glands who underwent surgical resection between January 2010 and February 2014 was performed. Twenty patients (16 women) were identified, with a mean age of 58.1±10.2 years. All patients presented with painless submandibular gland swelling. Diffuse gland enlargement, with clear margins and homogeneous density, was found on non-enhanced CT scans in all cases. There were no calcifications or stones within the involved glands. Based on contrast-enhanced CT appearance the patients could be divided into two groups: 11 cases showed homogeneous gland enhancement; and multiple hyperenhancing foci, with a crazy-paving pattern, were detected in 9 cases, which were in consistent with the pathologic findings. The maximum submandibular gland diameter on transverse images was significantly larger (P=0.008) in patients with crazy-paving appearance (32±4 mm) compared to patients with homogeneous enhancement (28±3 mm). It is concluded that the submandibular glands with IgG4-RSD can be characterized by either homogenous appearance or crazy-paving pattern on contrast-enhanced CT imaging.
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Affiliation(s)
- Zhiwei Wang
- Department of Radiology, Peking Union Medical College HospitalBeijing, 100730, China
| | - Ruie Feng
- Department of Pathology, Peking Union Medical College HospitalBeijing, 100730, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College HospitalBeijing, 100730, China
| | - Miao Duan
- Department of Radiology, Peking Union Medical College HospitalBeijing, 100730, China
| | - Man Wang
- Department of Radiology, Peking Union Medical College HospitalBeijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College HospitalBeijing, 100730, China
| | | | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College HospitalBeijing, 100730, China
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Sarkar A, Pitchumoni CS. The protean manifestations of IgG4-RD in gastrointestinal disorders. Dis Mon 2015; 61:493-515. [DOI: 10.1016/j.disamonth.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Wu A, Andrew NH, McNab AA, Selva D. IgG4-Related Ophthalmic Disease: Pooling of Published Cases and Literature Review. Curr Allergy Asthma Rep 2015; 15:27. [PMID: 26141575 DOI: 10.1007/s11882-015-0530-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In recent years, IgG4-related ophthalmic disease (IgG4-ROD) has emerged as a common cause of orbital inflammation, accounting for a substantial proportion of idiopathic orbital inflammation and lymphoid hyperplasia. The last pooled analysis of published cases was conducted in 2012, but a large number of new cases have been added to the literature since then. In this review, we present the demographic, clinical, histological, and treatment data for 172 published cases of biopsy-confirmed IgG4-ROD. Results are accompanied by a review of the relevant literature.
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Affiliation(s)
- Albert Wu
- South Australian Institute of Ophthalmology, University of Adelaide, Level 8, East Wing, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia,
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Abstract
IgG4-related disease (IgG4-RD) is relatively a new growing entity of immune-mediated origin, characterized by a mass-forming lesion, the infiltration of IgG4-positive plasma cells and occasionally elevated serum IgG4. It is considered to be both a systemic inflammation and sclerosing disease. The most common manifestations are parotid and lacrimal swelling, lymphadenopathy and autoimmune pancreatitis. Sclerosing cholangitis and retroperitoneal fibrosis are among the other mentioned frequent manifestations. The diagnosis should be approved histo-pathologically but other conditions such as lymphoma should be carefully excluded. Patients with IgG4-RD respond beneficially to glucocorticoid therapy especially when given at early onset stages. In some cases, the combination of immunosuppressive agents is required.
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Islam AD, Selmi C, Datta-Mitra A, Sonu R, Chen M, Gershwin ME, Raychaudhuri SP. The changing faces of IgG4-related disease: Clinical manifestations and pathogenesis. Autoimmun Rev 2015; 14:914-22. [PMID: 26112170 DOI: 10.1016/j.autrev.2015.06.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 02/08/2023]
Abstract
Since the earliest reports in 2001, immunoglobulin G4 (IgG4)-related disease has been defined as an autoimmune systemic disease characterized by the lymphoplasmacytic infiltration of affected tissues leading to fibrosis and obliterative phlebitis along with elevated serum IgG4 levels. Prior to this unifying hypothesis, a plethora of clinical manifestations were considered as separate entities despite the similar laboratory profile. The pathology can be observed in virtually all organs and may thus be a challenging diagnosis, especially when the adequate clinical suspicion is not present or when obtaining a tissue biopsy is not feasible. Nonetheless, the most frequently involved organs are the pancreas and exocrine glands but these may be spared. Immunosuppressants lead to a prompt clinical response in virtually all cases and prevent histological sequelae and, as a consequence, an early differential diagnosis from other conditions, particularly infections and cancer, as well as an early treatment should be pursued. We describe herein two cases in which atypical disease manifestations were observed, i.e., one with recurrent neck lymph node enlargement and proptosis, and one with jaundice. Our understanding of the pathogenesis of IgG4-related disease is largely incomplete but data support a significant role for Th2 cytokines with the contribution of innate immunity factors such as Toll-like receptors, macrophages and basophils. Further, macrophages activated by IL4 overexpress B cell activating factors and contribute to chronic inflammation and the development of fibrosis. We cannot rule out the possibility that the largely variable disease phenotypes reflect different pathogenetic mechanisms and the tissue microenvironment may then contribute to the organ involvement.
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Affiliation(s)
- Arshia Duza Islam
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA; VA Medical Center Sacramento, Mather, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Italy; BIOMETRA Department, University of Milan, Italy
| | | | - Rebecca Sonu
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Davis, CA, USA
| | - Mingyi Chen
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Davis, CA, USA
| | - M Eric Gershwin
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - Siba P Raychaudhuri
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA; VA Medical Center Sacramento, Mather, CA, USA.
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Cottom H, Mighell AJ, High A, Bateman AC. Are plasma cell-rich inflammatory conditions of the oral mucosa manifestations of IgG4-related disease? J Clin Pathol 2015; 68:802-7. [DOI: 10.1136/jclinpath-2014-202814] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/24/2015] [Indexed: 12/24/2022]
Abstract
AimThe aim of this study was to characterise plasma cell infiltrates, in terms of IgG4 positivity, in specific and non-specific plasma cell-rich chronic inflammatory conditions of the oral mucosa. Exploring the possibility that specific plasma cell-rich oral inflammatory conditions have association with or represent an oral manifestation of immunoglobulin G4-related disease (IgG4-RD).MethodsTen patients with plasma cell-rich chronic inflammatory conditions of the oral mucosa were identified (seven—plasma cell mucositis and three—non-specific diffuse oral mucosal inflammation with ulceration). For each patient, the clinical record and H&E-stained sections were reviewed. Immunohistochemistry for IgG and IgG4 antibodies was performed on sections from the corresponding paraffin block, permitting calculation of the mean number of IgG4+ plasma cells per high-power field (HPF) and the IgG4+/IgG+ plasma cell ratio.ResultsIn all the cases, only one histological hallmark of IgG4-RD—a dense lymphoplasmacytic infiltrate—was seen. Review of the medical histories did not reveal any features representing other manifestations of IgG4-RD. The number of IgG4+ plasma cells exceeded 100 per HPF in half of the cases. Only two cases had an IgG4+/IgG+ plasma cell ratio of >40%; both of which were in the non-specific oral inflammatory group.ConclusionsOur study suggests that plasma cell mucositis does not meet microscopic criteria for IgG4-RD. It importantly reinforces the opinion that IgG4+ plasma cells are major components of chronic inflammation in the oral cavity and the pertinence of correct contextual interpretation of histopathological features with clinical findings.
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