Utility of gastric biopsy in diagnosing IgG4-related gastrointestinal disease
Utility of gastric biopsy in diagnosing IgG4-related gastrointestinal disease
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DOI：
10.1111/pin.13059
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发表时间：
2020-12-30
影响因子：
2.2
通讯作者：
Matsukawa，Akihiro
中科院分区：
文献类型：
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作者：
Uchino，Kaori;Notohara，Kenji;Matsukawa，Akihiro
胃活检用于诊断免疫球蛋白（IG）G4相关胃肠道疾病（IgG 4-GID）的效用尚不清楚。底部重浆细胞增多症（BHP）是IgG 4-GID的一个独特特征。为了阐明使用胃活检诊断IgG 4 ‐GID中BHP的可行性，我们分析了31例已知IgG 4相关疾病（IgG 4 ‐RD）患者的胃活检标本的组织学特征和免疫染色，并评估了1696例连续常规胃活检中BHP的存在。每个高倍视野中IgG 4阳性浆细胞>10个且IgG 4/IgG阳性比率>40%的病例定义为IgG 4高。31例IgG 4 ‐RD患者中的10例被认为患有IgG 4 ‐GID，其中在粘膜的较深部分显著检测到IgG 4阳性浆细胞。6例显示BHP，而其余4例显示透壁浸润伴幽门螺杆菌相关性胃炎。除BHP外，我们还确定了IgG 4-GID的两个独特组织学特征：粘膜肌层中的浆细胞聚集和非萎缩粘膜中胃底腺之间的渗透性浆细胞浸润。6例常规病例（0.35%）显示BHP，包括1例IgG 4 ‐RD病例。可通过存在具有特征性组织学特征的胃活检标本来怀疑IgG 4 ‐GID。建议对此类病例进行进一步检查，以确定是否存在IgG 4-RD。
The utility of gastric biopsy for diagnosing immunoglobulin (Ig)G4‐related gastrointestinal disease (IgG4‐GID) remains unclear. Bottom‐heavy plasmacytosis (BHP) is a distinct feature of IgG4‐GID. To clarify the feasibility of using gastric biopsies to diagnose BHP in IgG4‐GID, we analyzed the histological features and immunostaining of gastric biopsy specimens from 31 known IgG4‐related disease (IgG4‐RD) patients and we assessed the presence of BHP in 1696 consecutive routine gastric biopsies. Cases with both >10 IgG4‐positive plasma cells per high‐power field and an IgG4/IgG‐positive ratio >40% were defined as IgG4‐high. Ten of the 31 IgG4‐RD patients were concluded to have IgG4‐GID, in which IgG4‐positive plasma cells were notably detected at the deeper part of the mucosa. Six cases displayed BHP whereas the remaining four cases showed transmural infiltration with concomitantHelicobacter pylori‐associated gastritis. In addition to BHP, we identified two unique histologic features for IgG4‐GID: plasmacytic aggregation in the muscularis mucosae and permeative plasmacytic infiltration between fundic glands in the non‐atrophic mucosa. Six of the routine cases (0.35%) displayed BHP, including a case with IgG4‐RD. IgG4‐GID can be suspected by the presence of gastric biopsy specimens with characteristic histological features. Such cases are recommended to undergo further examinations to determine whether IgG4‐RD is present.