IgG4-positive plasma cells in granulomatosis with polyangiitis (Wegener's): a clinicopathologic and immunohistochemical study on 43 granulomatosis with polyangiitis and 20 control cases
IgG4-positive plasma cells in granulomatosis with polyangiitis (Wegener's): a clinicopathologic and immunohistochemical study on 43 granulomatosis with polyangiitis and 20 control cases
复制标题
DOI：
10.1016/j.humpath.2013.05.023
复制
发表时间：
2013-11-01
期刊：
影响因子：
3.3
通讯作者：
Yi, Eunhee S.
中科院分区：
文献类型：
--
作者：
Chang, Sing Yun;Keogh, Karina A.;Yi, Eunhee S.
多血管炎肉芽肿病（GPA） （Wegener's）在一些活检的组织学检查上可能与igg4相关疾病（IgG4-RD）相似，特别是头颈部部位。在这种情况下，IgG4免疫染色通常用于IgG4- rd的鉴别诊断。在此，我们报告了43例GPA的IgG4阳性（IgG4+）细胞的结果，其中包括26例先前发表的病例以及新增加的肺和肾病例。我们还纳入了20例没有任何临床证据表明GPA或IgG4-RD的对照病例，包括湿疹（n = 8），慢性鼻窦炎（n = 8），慢性鼻窦炎（n = 8）。慢性扁桃体炎（n = 4）。43例活检诊断为GPA，分别来自鼻窦黏膜/口腔/鼻咽部（n = 14）、眼眶/眶周组织（n = 7）、肺/胸膜（n = 14）、肾脏（n = 4）、皮肤（n = 3）和硬脑膜（n = 1）。43例活组织检查中，8例（18.6%）发现IgG4+细胞增加（高倍视野下>增加30个，IgG4+/IgG+比例下>增加40%），起源于鼻窦（n = 4）或眶/眶周（n = 4）区域。这些病例的IgG4+细胞和IgG4+/IgG+比值分别为37 ~ 139 /高倍视场和44% ~ 83%。对照病例中IgG4+细胞均未增加。总之，在GPA的鼻窦或眶/眶周活检中可以看到IgG4+细胞的增加，这可能是诊断IgG4- rd的一个陷阱。然而，当使用上述阈值时，其他器官和对照的GPA并未显示IgG4+细胞增加。在涉及头颈部的GPA病例中，IgG4+细胞增加的生物学或临床意义尚不确定，可能需要进一步的研究来解决这些病例中IgG4- rd与GPA之间潜在的致病关系。(C) 2013爱思唯尔公司版权所有。
Granulomatosis with polyangiitis (GPA) (Wegener's) may mimic IgG4-related disease (IgG4-RD) on histologic examination of some biopsies, especially those from head and neck sites. IgG4 immunostaining is often performed in this context for differential diagnosis with IgG4-RD. Herein, we report the results of IgG4-positive (IgG4+) cells in 43 cases of GPA including 26 previously published cases as well as the newly added cases from the lung and kidney. We also included 20 control cases without any clinical evidence of GPA or IgG4-RD that consisted of chalazion (n = 8), chronic sinusitis (n = 8),. and chronic tonsillitis (n = 4). Forty-three biopsies diagnosed as GPA were from sinonasal mucosa/oral cavity/nasopharynx (n = 14), orbit/periorbital tissue (n = 7), lung/pleura (n = 14), kidney (n = 4), skin (n = 3), and dura (n = 1). Of 43 biopsies, 8 (18.6%) revealed increased IgG4+ cells (>30 per high-power field and >40% in IgG4+/IgG+ ratio) and originated from sinonasal (n = 4) or orbital/periorbital (n = 4) regions. The IgG4+ cells and IgG4+/IgG+ ratio hi these cases ranged from 37 to 139 per high-power field and 44% to 83%, respectively. None of the control cases had increased IgG4+ cells. In conclusion, increased IgG4+ cells can be seen in sinonasal or orbital/periorbital biopsies of GPA, which could pose as a pitfall in the diagnosis of IgG4-RD. However, GPA in other organs and controls did not show increased IgG4+ cells when using the above threshold. The biologic or clinical importance of increased IgG4+ cells in GPA cases involving head and neck region is uncertain, and a further study might be warranted to address the potential pathogenic relationship between IgG4-RD and GPA in those cases. (C) 2013 Elsevier Inc. All rights reserved.