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Meli M, Arrabito M, Salvatorelli L, Soma R, Presti S, Licciardello M, Miraglia V, Scuderi MG, Belfiore G, Magro G, Russo G, Di Cataldo A. Report of Two Cases of Pediatric IgG4-Related Lymphadenopathy (IgG4-LAD): IgG4-Related Disease (IgG4-RD) or a Distinct Clinical Pathological Entity? CHILDREN (BASEL, SWITZERLAND) 2022; 9:1472. [PMID: 36291407 PMCID: PMC9600987 DOI: 10.3390/children9101472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
IgG4-related disease (IgG4-RD) is a recently discovered immune-mediated fibroinflammatory condition, uncommon in the pediatric population, that could involve multiple organs and induce cancer-like lesions and organ damage. Its main features are multiple injuries in different sites, a dense lymphoplasmacytic infiltrate rich in IgG4 plasma cells, storiform fibrosis, and often high serological concentrations of IgG4. Autoimmune pancreatitis is the most common manifestation, mainly in adults. Two cases of IgG4-RD in children with lymph node localization of disease are reported. Localized or systemic lymph node involvement is common, but lymph node enlargement as the first and only manifestation of IgG4-RD is unusual, and therefore, hard to differentiate from other diseases. IgG4-related lymphadenopathy (IgG4-LAD) is most likely a distinct disease, described as isolated lymphadenopathy, related to the presence of elevated numbers of IgG4-positive plasma cells. Both disorders are likely to be misdiagnosed in children because they are characterized by rare and polymorphic features. IgG4-RD and IgG4-LAD should be considered in the differential diagnosis of disorders characterized by lymphadenopathy of uncertain etiology.
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Affiliation(s)
- Mariaclaudia Meli
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Marta Arrabito
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Lucia Salvatorelli
- Anatomic Pathology Unit, University Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Rachele Soma
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Santiago Presti
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Maria Licciardello
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Vito Miraglia
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Maria Grazia Scuderi
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia, University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Giuseppe Belfiore
- Unit of Paediatric Radiology, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Gaetano Magro
- Anatomic Pathology Unit, University Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Giovanna Russo
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Andrea Di Cataldo
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
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Unique Ultrasonographic Findings of Isolated IgG4-Related Lymphadenopathy. Diagnostics (Basel) 2021; 11:diagnostics11122213. [PMID: 34943450 PMCID: PMC8700604 DOI: 10.3390/diagnostics11122213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 12/04/2022] Open
Abstract
IgG4-related disease is a rare immune-mediated disease that can involve many organs in the body. The lymph node is also where IgG4-related diseases occur, but its histological structure is different from that of other organs. For this reason, pathologists have difficulty diagnosing IgG4-related lymphadenopathy. If there were specific imaging findings of IgG4-related lymphadenopathy, it would be of great help to pathologists. A 64-year-old male visited our hospital with right ankle pain. On physical examination, the right lower extremity showed severe swelling with wound dehiscence, and infection was suspected. On CT (128-MDCT, Somatom Definition Flash, Siemens Healthcare) taken at the lower extremity, multiple enlarged lymph nodes were incidentally noted in the right inguinal area. On ultrasonography, a “starry night sign” resembling hyperechoic follicles was observed in the enlarged lymph node. A core needle biopsy was performed, and IgG4-related lymphadenopathy was diagnosed. Laboratory examination showed hypergammaglobulinemia with marked elevated serum IgG4, corresponding to IgG4-related disease. Chest and abdominal imaging were evaluated, but there was no extranodal IgG4-related disease. IgG4-related lymphadenopathy showed a very unique ultrasonography imaging finding. The cortex was filled with diffusely scattered hyperechoic foci and some bright foci gathered to form a follicle. This imaging finding may help diagnose IgG4-related lymphadenopathy.
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Zhang YX, Xue JP, Li HZ, Miao JW, Kang CS. Clinical Value of Shear Wave Elastography Color Scores in Classifying Thyroid Nodules. Int J Gen Med 2021; 14:8007-8018. [PMID: 34785943 PMCID: PMC8590981 DOI: 10.2147/ijgm.s331406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the clinical value of qualitative shear wave elastography (SWE) color in the differential diagnosis of benign and malignant thyroid nodules. Methods From January 2017 to July 2018, 241 patients with 261 thyroid nodules, who underwent conventional ultrasonography and SWE examination before surgical resection, were enrolled. The nodules were also evaluated by histopathologic analyses. The SWE color characteristics that could differentiate malignant and benign thyroid nodules were selected and scored based on the malignancy rate. The diagnostic performances were evaluated by receiver operating characteristic (ROC) curves analysis. Results Among the 261 thyroid nodules, 58 were benign, and 203 were malignant. Malignancy was associated with orange or red as the color of maximum hardness inside a nodule, green as the primary color, with a “stiff rim,” inhomogeneous internal color, and inhomogeneous color between the nodules and its surrounding areas. The SWE color scores for benign thyroid nodules were mainly 0 and 1, while 4 and 5 were for malignant thyroid nodules. The area under the ROC curve (AUC) of the SWE color score ≥3 for the diagnosis of malignant thyroid nodules was 0.828 (95% CI: 0.764, 0.891) with a sensitivity of 82.8%, a specificity of 82.8%, and an accuracy of 83.1%. Additionally, conventional ultrasound combined with SWE color scores had a higher diagnostic performance than conventional ultrasound (AUC 0.820 vs AUC 0.796, P = 0.04). Conclusion The SWE color scores might be a convenient and effective method to assist in differentiating thyroid nodules.
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Affiliation(s)
- Yan-Xia Zhang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Ji-Ping Xue
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Hui-Zhan Li
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Jun-Wang Miao
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Chun-Song Kang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
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Zhang J, Zhao L, Zhou J, Dong W, Wu Y. Immunoglobulin G4-related periodontitis: case report and review of the literature. BMC Oral Health 2021; 21:279. [PMID: 34049546 PMCID: PMC8161922 DOI: 10.1186/s12903-021-01592-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/26/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory systemic disease of unknown etiology that can affect one or multiple organs. The disease can mimic many infectious and inflammatory diseases, mainly causing organ enlargement or hyperplasia. Its diagnosis primarily relies on clinical, serologic, and histological features (lymphoplasmacytic infiltrates, storiform fibrosis, and obliterative phlebitis of IgG4 + plasma cells). Here, we report a rare case of IgG4-related periodontitis, and review the relevant literatures. CASE PRESENTATION A 38-year-old Chinese man visited the Department of Periodontics with gingival enlargement, loose teeth, and tooth loss. The patient had very poor oral hygiene and a large amount of calculus. Gingivae were edematous with deep periodontal pockets and attachment loss. Panoramic radiography showed alveolar bone loss. Serologic examination showed that IgG was 23.70 g/L and IgG4 concentration was 2.800 g/L. There was significant lymphoplasmacytic infiltration, a storiform pattern of fibrosis, and mitotic figures with hematoxylin and eosin staining; immunohistochemical staining showed 10 scattered IgG4-positive plasma cells in a high-power field. The patient was diagnosed as IgG4-related periodontitis. He received a course of corticosteroids with periodontal therapy, and the enlargement was significantly improved without recurrence. CONCLUSION IgG4-RD in the oral and maxillofacial region mainly involves salivary glands, but this rare case was characterized by enlarged gingivae. The differential diagnosis of IgG4-RD should be based on the clinical features and serologic (IgG4) and histopathological examinations. Corticosteroid therapy is effective for most IgG4-RD patients. Taken together, we hope this case report and the literature review can help dentists to improve their understanding of the IgG4-RD.
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Affiliation(s)
- Jinmei Zhang
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Lei Zhao
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Jieyu Zhou
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Wei Dong
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China
| | - Yafei Wu
- National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China.
- Department of Periodontics, West China School and Hospital of Stomatology, Sichuan University, No. 14 Renim South Road 3rd Section, Chengdu, 610041, Sichuan, China.
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